Progress in labour after colposcopy treatment

Colgan, Valerie (2010) Progress in labour after colposcopy treatment. Doctoral thesis, Northumbria University.

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Abstract

Anomalies noticed in midwifery practice prompted a review of literature around progress in labour after Loop Excision of the Transformation Zone (LETZ). The previous research was equivocal. This study investigates the pattern and progress of women's labours following LETZ, and the effect of the experience on women. It also explores the basis of clinical decisions made by midwives. It takes place in North East England and involves women giving birth in 2004-2005. The case study strategy brings together quantitative retrospective case control results, qualitative analysis of semi-structured interviews from women and midwives, and guidelines and protocols surrounding assessment and management of labour. The quantitative data is from 111 women after LETZ and 214 controls, reducing to 94 and 150 respectively after removal of cases with confounding variables. Interviews are from four women, three individual midwives caring for one of the women and a focus group of four midwives. In the interviews, women gave no thought to how their births may be affected by LETZ, as no one had discussed the possibility with them. Women having their second baby after LETZ take less time to reach full dilatation; a result related to grade of Cervical Intraepithelial Neoplasia. Women having their first baby after LETZ are 1.8 times more likely to be admitted later in their labours, an important emergent issue that needs further research. Women having their first or second baby after LETZ are 2.3 times more likely to have a premature birth, confirming indications in previous research. This study for the first time reveals important differences in pattern and progress of labour after LETZ. It adds to our knowledge of premature birth after LETZ. Midwives, obstetricians and colposcopists need to incorporate the study results into counselling of women before LETZ and during any pregnancy after LETZ.

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