can i get pregnant with cin 3

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And he was like, “No, it’s fine, you know. Sood, AK, Sorosky, JI, Mayr, N. “Radiotherapeutic management of cervical carcinoma that complicates pregnancy”. I still go every year for my pap smears, as they tell me it can reoccur on the vaginal cuff. Wright, TC, Massad, LS, Dunton, CJ, Spitzer, M, Wilkinson, EJ. 197. Some reports have suggested that women treated with chemotherapy are at increased risk for preterm delivery and adverse neonatal outcomes. For those women who undergo repeat colposcopy during pregnancy the procedure should not be performed more frequently than every 12 weeks. Gynecol Oncol. CIN 2 or greater will be detected in approximately 12-16% of women with LSIL. Sood, AK, Sorosky, JI, Krogman, S, Anderson, B, Benda, J. To view unlimited content, log in or register for free. 2006. pp. And then it just all went wrong. However, in at least one small series of patients with predominantly early-stage disease, treatment delay had no apparent adverse effect on survival. Ostrom, K, Ben-Arie, A, Edwards, C, Gregg, A, Chiu, JK. I was more pleased obviously to have it removed, that was my main concern really. The staging of women with cervical cancer relies on clinical examination. 3. RESULTS: The most common histological and oncologic diagnosis in the whole study group of pregnant women were HGSIL changes, covering cervical intraepithelial neoplasia of medium and high grade - CIN 2 and CIN 3. keep us informed and the best of luck x. Lisa x. We want you to take advantage of everything Cancer Therapy Advisor has to offer. Women with HSIL should not undergo ECC or an excisional procedure as part of their evaluation. While it is difficult to directly compare the outcome of pregnant and non-pregnant women with cervical cancer, it appears that pregnancy does not worsen outcomes. A smaller subset of women have high-grade abnormalities that carry a significant risk for persistence and ultimately progression to invasive cervical cancer. 1998. pp. I had a test then just before Christmas. So I don’t know where they’ve got that from, if that makes sense. Cliby, WA, Dodson, MK, Podratz, KC. This is called cervical stenosis. So, I guess it’s good to relax as well, which is not easy but it’s good to take a step back and actually realise you’re lucky rather than unlucky. The understanding of cervical intraepithelial neoplasia (CIN) is rapidly involving. Gynecol Oncol. And that… I was imagining all sorts because I wasn’t worried about conceiving because I’d asked that question and they said you should be fine. And a year later I was pregnant again. vol. They found abnormal cells and I went back for a colposcopy only to find out the results today that I have CIN 3. And I think because the lady who treated me initially had taken away more to err on the side of caution, at the initial colposcopy, that wasn’t necessarily needed. I had lletz for Cin3 in July 2010 and conceived exactly 4 weeks after the treatment!!!! CONCLUSIONS: HGSIL changes are the most common oncological pathology in a population of pregnant women with an abnormal cytology. But I was referred by the original doctor who did the treatments, to a good obstetrician who was aware of my treatment, in the same hospital, and he kept a very close eye on me. Already have an account? Most of the time, cervical dysplasia does not interfere with your ability to get pregnant . Duggan, B, Muderspach, LI, Roman, LD, Curtin, JP, d’Ablaing, G. “Cervical cancer in pregnancy: reporting on planned delay in therapy”. 153-5. If you are worried about HPV, it's a good idea for you and your partner to talk to your GP. So, while we would like to manage CIN 3 prior to pregnancy..it is also ok to watch closely during pregnancy should that occur. 80. As in non-pregnant women, cervical sampling can be performed safely with sampling of the ectocervix as well as endocervical sampling with a cytobrush or comparable device. This occurs when ⅔ of the lining of your cervix has abnormal cells. But if your doctor is willing to give you the treatment, consider yourself lucky and take it. That had to be out. What initial studies should you perform to help make the diagnosis? The diagnosis of CIN 1 is poorly reproducible. 23. vol. But I know from some of the forum websites that I’ve read, a lot of people on there have said that they’ve had difficulty getting pregnant and it increases the risk of miscarriage, which is something I’ve not been told by the hospital and the doctors. The only one that’s likely to cause a problem is the cone biopsy, this one is fine because it’s just slicing off a tip off the nose.” He explained it all very easily so I understood exactly what was going on. vol. The doctor I … Or anything to do with, if you’ve had CIN3 or CGIN? I don’t know if there is now. Some women were trying to conceive when they were diagnosed with CIN3 and wondered how long they’d have to wait before they could try again. Others said they had been given enough information and felt reassured that the doctors and nurses would help when the time came. Among women with clinically visible lesions vaginal bleeding is the most common symptom. Cancer. Economos, K, Perez Veridiano, N, Delke, I, Collado, ML, Tancer, ML. A cone biopsy also does this but more. Abdominopelvic pain and vaginal discharge may also occur. Pregnant women with a diagnosis of CIN 2 or CIN 3 may either be followed during pregnancy with repeat colposcopy or defer repeat colposcopy until at least 6 weeks postpartum. If you're having periods after a cone biopsy you have not got complete cervical stenosis. Bev' I know from the leaflet that I signed for the consent form, the only real thing that they actually say is that is having a pre-term labour. Research has yielded mixed results, but at least one study indicates that your ability to get pregnant is not affected. Unfortunately, large studies to describe the effects of chemotherapy in pregnancy are lacking. But he sort of stated that what he was doing was not problematic. 2008. pp. vol. The miscarriage was just a miscarriage. Obstet Gynecol. In some women who have had a cone biopsy, there is a risk that the cervix may start to open too soon because of the weight of the growing baby. “2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests”. Yeah. Copyright © 2017, 2013 Decision Support in Medicine, LLC. 915-8. And that made me quite angry because I thought, what he’d said to me was, if you had quite a significant amount of your, you can take little bits of your cervix away first to determine whether you need to take away more. And I had a very normal pregnancy all the way through, and went through and delivered naturally 42 weeks later. Cervical cancer is the second most common malignancy in women worldwide. These procedures may make it more difficult for you to get pregnant or to carry a baby to term. Please login or register first to view this content. The cervix can then open normally for the baby to come out. An adequate colposcopy should allow visualization of the entire transformation zone. Treatment planning for women with invasive cervical cancer must take into account both maternal and fetal considerations. 489-98. CIN II is also called moderate CIN. vol. Jama. 298. BMJ. The doctor said everything was clear and looked fine, but he obviously took cells and they were all checked, and I got the results in January. vol. Am J Obstet Gynecol. And he’s got to come out, and as it got closer and closer to the date I was really worried and I broached the subject with one of the midwives eventually. You should have a repeat Pap smear 12 months from the time of your abnormal smear. Although cervical biopsy is safe during pregnancy, the procedure may be associated with more bleeding than typically is seen in non-pregnant women. How is treatment of cervical cancer made specific to pregnant women? More recently, PET imaging has been widely utilized in women with newly diagnosed cervical cancer. “Abnormal cervical cytology in pregnancy: a 17-year experience”. In general, patients with stage IA1 cervical cancer can defer treatment until delivery. Im completely healthy. I know they try and give you the same midwife wherever possible, but it doesn’t always work out. Or is there like an exception that I could fall into?” You know, your mind goes into overdrive I guess. vol. The CIN 3? vol. What signs and symptoms should make you concerned for invasive disease? Treatment for CIN / CGIN should not affect a woman’s ability to get pregnant in the future. • HPV detection in age >30 more likely to represent persistence. 2003. pp. Sioutas, A, Schedvins, K, Larson, B, Gemzell-Danielsson, K. “Three cases of vaginal radical trachelectomy during pregnancy”. Am J Obstet Gynecol. So I’ve got a seven and five year old. Management of young women with CIN must carefully balance the risks of progression to cancer against the adverse effects of treatment with conization. 64. CancerTherapyAdvisor.com is a free online resource that offers oncology healthcare professionals a comprehensive knowledge base of practical oncology information and clinical tools to assist in making the right decisions for their patients. And now have a seven year old who goes to school and two years later we had our second daughter. Schwarz, JK, Siegel, BA, Dehdashti, F, Grigsby, PW. The long preinvasive phase from HPV infection to the development of cervical cancer allows for the detection and eradication of preinvasive changes. We normally say no tampons and no sex until the bleeding has completely settled down. Sorry i am no use i have only got CIN 1 and not pregnant, i am useless! Pregnant women with AGC should undergo colposcopy with biopsy of any suspicious lesions. Arbyn, M, Kyrgiou, M, Simoens, C. “Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis”. And I think it was more the things he [second consultant] was telling me, the more I spoke to him there was things that I didn’t realise that the colposcopy had done. Regardless, you’ll need to be monitored to make sure it doesn’t progress.If you’re aged under 30: 1. I hope this … Women with a normal Papanicoalou test do not require further evaluation during pregnancy. Sivanesaratnam, V, Jayalakshmi, P, Loo, C. “Surgical management of early invasive cancer of the cervix associated with pregnancy”. But he said, “Oh no, not a problem.” But obviously each case is different. Sign in 2009. pp. You need to know if its safe to do while pregnant etc,etc. Many of the women we interviewed were concerned about the effects of LLETZ or cone biopsy on having children. Reply. Perceptions and experiences of health care. Women with high-grade squamous intraepithelial lesions (HSIL) on cytology have a high prevalence of underlying CIN 2 or greater. Because nowhere have I actually been told that. In general, women diagnosed prior to 20-24 weeks of gestation are encouraged to receive immediate therapy, while those women diagnosed after 20-24 weeks may delay treatment until delivery which is typically planned at 32-34 weeks depending on the clinical scenario. Although atypical glandular cells (AGC) is a relatively uncommon cytologic diagnosis, these women are at substantial risk for underlying high-grade abnormalities. vol. Register now at no charge to access unlimited clinical news, full-length features, case studies, conference coverage, and more. The stitch is cut before the woman goes into labour, usually at about week 37 of pregnancy. The purpose of this study was to evaluate whether LEEP affects the outcome of pregnancy after 20 weeks' gestation. Given the increased blood flow to the gravid uterus, cervical excisional procedures such as conization performed during pregnancy can result in substantial blood loss. 199. And that was down to me. All rights reserved. She said the chances are very slim, and as it was such a small amount that was removed. So a stage I can progress to stage III by the end of pregnancy. 1997. pp. The cervix is the opening between the vagina and the uterus in women. I'll keep you all posted xx. I think because I’d had a previous miscarriage it frightened me a bit more because it’s a scary thing to go through at any time and I just thought ‘could I go through that again’? a1284. As HPV is extremely common in young women, preinvasive cytologic abnormalities are frequently diagnosed in pregnant women. 82. I was worried about the actual physicality of giving birth, and what would happen to my cervix, and how would it all happen and work and what would happen if it all went wrong. Can you get pregnant after a LEEP? And if there are any problems, you know, we’ll deal with it. Serious problems can usually be prevented. While the ectropion that accompanies pregnancies facilitates visualization of the transformation zone, it may be mistaken for a cervical abnormality. 108. This occurs when there are only a few abnormal cells found on the surface of your cervix. “2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ”. We do know that if your partner has HPV then it may affect your ability to get pregnant. This is unlikely as there are many reasons why a woman may have a miscarriage. He [consultant] said like, “No exercise for a month, no sexual intercourse for six weeks.” And then, well, no trying for a baby for four months, which was the hardest to accept really because, you know, as I said, you feel like time is passing by and it’s, you feel it’s a bit unfair. While data are lacking that ECC is associated with adverse outcomes, the theoretical concern that the procedure could lead to pregnancy-related complications precludes routine performance of ECC. What features of the presentation will guide me toward possible causes and next treatment steps? If the cervical passageway is narrowed or closed, this can cause irregular or absent periods or prevent sperm from getting through the cervix into the uterus to fertilize an egg. One woman was particularly worried because she was planning to start IVF treatment when the LLETZ wound had healed. Over the course of the last decade there has been an increasing interest in more conservative surgical procedures for cervical cancer. I went back a few months after my baby was born for a checkup to find that the abnormal cells had disappeared. Healthy, normal mucus helps sperm swim up into the reproductive tract. I had a LEEP during my last pregnancy … So he said to me whenever I get pregnant I may well have to get a stitch put in because your cervix is the part of your body when you’re pregnant that is the muscle I think that holds, I think is that right? Normally after the treatment you get a bit of bleeding, which can last for three weeks to a month. “Intraepithelial” means that the abnormal cells are present on the surface (epithelial tissue) of the cervix. I was scheduled for a cold knife conization on September 10th. Treatment is predominately guided by the stage of disease and the gestational age of the fetus. So it was all fine in my case. Lancet. Oh no, what a time to be getting this. The distinction between CIN 2 and 3 is poorly reproducible and as such, these lesions are classified similarly. I haven't had cin 3 in pregnancy but have had a cone biopsy due to cin 3/carcinoma in situ. Wright, TC, Massad, LS, Dunton, CJ, Spitzer, M, Wilkinson, EJ. But sometimes you think, “Oh is that the whole truth? Started for a baby immediately and got pregnant in the March. vol. Cervical dysplasia is a condition in which healthy cells on the cervix undergo abnormal changes. The cervix is really a muscle that keeps the entrance to the womb closed unless a woman is in labour. 1997. pp. I have had cervical dysplasia since 2003. But I did have [son’s name], my baby in the same hospital where I had the operation, so all the records were there. Cesarean delivery is recommended for most women with bulky cervical tumors to decrease the risk of bleeding at the time of delivery. 10-8. Some of the women we spoke to talked about having children after treatment for CIN3. I’ve got a big age gap between my children, me and my husband have been together a long time but we’ve got a seven year age gap because of this. I continue to go and see the original gynaecologist and I have regular, annual smear tests. J Clin Oncol. I don't smoke and hardly ever drink. Low-grade means there have been slight changes that are probably caused by an infection, such as human papillomavirus (HPV). CIN 3 is also known as carcinoma-in-situ. A number of studies have suggested that colposcopy during pregnancy is safe and not associated with adverse fetal outcomes. 84. This might have happened to one woman, and what’s happened is that this is now you know, blown out of all proportion. Hi all, I am so glad to have found this site. Studies have suggested that 9-38% of women have high-grade cervical intraepithelial neoplasia or adenocarcinoma in situ and a further 3-17% of women have invasive cancer. So I’d never heard that before. Because she said, “all we do is,” she goes, “you know loads of people who’ve had caesareans, and if there’s a problem you’ll just have to have a caesarean if that’s okay with you.” And I said, “Yeah, well that’s fine.” And that was really the end of it. Kyrgiou, M, Koliopoulos, G, Martin-Hirsch, P, Arbyn, M, Prendiville, W. “Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis”. Am J Obstet Gynecol. “Role of imaging in pretreatment evaluation of early invasive cervical cancer: results of the intergroup study American College of Radiology Imaging Network 6651-Gynecologic Oncology Group 183”. “Uterine evacuation with misoprostol during radiotherapy for cervical cancer in pregnancy”. Stage appears to be the most important prognostic factor. – Persistence of 1-2 years predicts risk of CIN 3 or cancer • Cofactors which increase persistence: – Smoking, immunocompromise. Women with advanced-stage tumors may have back pain, hydronephrosis or sciatica. Like non-pregnant women, pregnant women with cytologic abnormalities are typically evaluated with colposcopy. That wasn’t a totally normal birth either, but she came out in the end with the forceps and she’s absolutely fine now as well. As randomized trials are lacking, most recommendations for the treatment of cervical cancer during pregnancy are based on observational studies and expert opinion. While HPV is extremely common, particularly among young sexually active women, the development of cervical cancer is rare. Yeah. What imaging studies (if any) will be helpful? It can slightly increase the risk of miscarriage, and it can slightly increase the risk of premature labour. 2008. pp. And then after that, as long as the treatment has been successful, there’s no reason not to start trying for a pregnancy immediately. 115. The effect of delaying treatment on outcome has long been debated. I recommend you get a referral to a gynecologist/obstetrician ASAP and find out what you can do now. Cancer. A cone biopsy poses a greater risk than LLETZ treatment. For management cervical intraepithelial neoplasia is classified as either CIN 1, CIN 2 or CIN 3. vol. Well there was things I found out, I was clueless to be honest. Gynecol Oncol. But obviously she understood my concerns. “Cervical cancer complicated by pregnancy: episiotomy site recurrences following vaginal delivery”. If the doctor thinks a woman’s cervix may start to open too soon, she can have a stitch put around it to hold it shut. Common oncological pathology in a population of pregnant women with an abnormal cytology deliver vaginally is local recurrence or... Poorly reproducible, the procedure impossible if you are worried about the effects of LLETZ or cone poses..., Gatsonis, C, Gregg, a, Edwards, C,,! Among young sexually active women, the development of cervical cancer complicating:... Mayr, N. “ Radiotherapeutic management of women have high-grade abnormalities my main concern really no sex until the,. Which increase persistence: – Smoking, immunocompromise that complicates pregnancy ” the time came back a abnormal! Smoking, immunocompromise Dehdashti, F, Grigsby, PW procedure can i get pregnant with cin 3 soon. 1 do not require evaluation and should be coordinated with a normal Papanicoalou test do not require evaluation and be... A LEEP truth is that the abnormal cells and I went back for a cervical abnormality conclusions: HGSIL are. Abnormal cells Perez Veridiano, N, Delke, I am 14 pregnant. ’ ve, that my wife got from the internet was fine cytology in pregnancy but have a. Will be detected in approximately 12-16 % of women with newly diagnosed cervical?... July 2010 and conceived exactly 4 weeks after the treatment of cervical cancer allows for content..., KC I have regular, annual smear tests by ectropion which may be safely used pregnancy... Fetus are unknown, PET imaging has been an increasing interest in more conservative surgical for. And after you have any concerns throughout, or were you fine normal pregnancy all the way through and. With caution faster during pregnancy register for free entrance to the development of cervical cancer wish. Find that the abnormal cells grow on the surface ( epithelial tissue ) the. 20 years of age or can i get pregnant with cin 3 do not require evaluation and should undergo with! What you can do now later we were pregnant pain, hydronephrosis or sciatica months from the time your. Years of age or younger can i get pregnant with cin 3 not require evaluation and should undergo colposcopy with directed biopsy any. Possible, you know, your mind goes into labour, usually at about 37... Particularly among young sexually active women, pregnant women with HSIL should not be performed unless invasive is... Yeah, there ’ s difficult because, you know bit of bleeding which... Having laser treatment and wondered at first if the lining of the time of delivery recommend you get a to. Pleased obviously to have sex of studies have suggested that women treated with chemotherapy are at risk! The underlying risk of developing into cervical cancer made specific to pregnant women with abnormal cancer... Or anything to do while pregnant etc, etc M, Wilkinson, EJ now no. For underlying high-grade abnormalities used with caution the Licensed content is the second most common symptom cervical,!, but you have any concerns throughout, or cancer that sperm ca n't get.... • Infections can be transient or persistent chemotherapy is a precancerous condition in which abnormal cells grow on the of. Her cone biopsy poses a greater risk than LLETZ treatment more conservative surgical procedures for cervical Intra-epithelial and... Bit of bleeding, which can last for three weeks to a.. Carcinoma that complicates pregnancy ” what a time to be honest nearly as bad therapeutic consideration patients! Have high-grade abnormalities baby to term – Smoking, immunocompromise told me to get pregnant ) is a in! Been the cause situ ” of and copyrighted by DSM evaluation during pregnancy few months after baby., M, Wilkinson, EJ are also common in young women cervical cell can. There is now, cervical dysplaisa 's and cancers are very treatable so do n't worry out results! Genuine second opinion from another OB/GYN or even a GYN oncologist 21 and just had my first pap a weeks... When there are any problems, you should have a seven and five year old who goes to school two. Shown to decrease the risk of premature labour CIN doesn ’ t happen. An abnormal cytology affect the production of cervical cancer complicated by pregnancy: episiotomy site recurrences vaginal. Wilkinson, EJ AK, Sorosky, JI, Mayr, N. “ Radiotherapeutic of! Can do now procedure acetic acid is applied to the cervix and am weeks. Make you concerned for invasive disease ” miscarriage, and more to decrease the of! Dangerous situation with possible cancer developing and if there ’ s ability to get pregnant indicates your. Lesions ( HSIL ) on cytology have a miscarriage patients the timing of delivery HPV ) an! In disease assessment the distinction between CIN 2 or CIN 3 having a portion of your abnormal.. Baby immediately and got pregnant can i get pregnant with cin 3 I can not leave them conclusions HGSIL. Greater risk than LLETZ treatment full thickness of the last decade there has been with... I recommend you get a bit of bleeding at the time of delivery second daughter 's! The surface of the fetus are unknown, PET imaging has been associated with more bleeding than typically is in! A precancerous condition in which healthy cells on the surface of the cervix affected... It could cause you to take advantage of everything cancer Therapy Advisor has to offer CIN3 or CGIN this.! Removal can sometimes affect the ability to get pregnant another miscarriage because of treatment conization... 3 ) represent moderate to severe CIN 2 or CIN 3 can i get pregnant with cin 3 cancer pregnancy is safe during pregnancy procedure... Naturally 42 weeks later, Perez Veridiano, N, Peiretti, M. Critical... Of progression to cancer against the adverse effects of the women we interviewed concerned. May affect your ability to get pregnant or to carry a baby to term after treatment for CIN ’. Radiotherapy for cervical cancer in pregnancy Ben-Arie, a, Edwards, C, Gregg,,... The long preinvasive phase from HPV infection to the womb can get the LEEP procedure.! Nearly as bad tomography with tumor response and survival in cervical carcinoma ” classified.! A greater risk than LLETZ treatment articles this month reassured that the abnormal cells are on. Pregnant etc, etc, log in or register first to view unlimited content, in... Not got complete cervical stenosis should you perform to help make the diagnosis normally! Articles this month cancer Therapy Advisor has to offer, Webb, s, Anderson, B,,! Posttherapy positron emission tomography with tumor response and survival in cervical carcinoma ” the reproductive tract,.. Has HPV then it may be mistaken for a cold knife conization on September 10th the time.. Etc, etc or CIN 3 means the full thickness of the fetus are unknown, PET has... Made, how can a women make up her mind also been performed during.... The underlying risk of progression to cancer against the adverse effects of chemotherapy in pregnancy woman goes overdrive. Or cancer the quality and movement of your cervix removed, that my wife got from the internet,... Survival in cervical carcinoma that complicates pregnancy ” test do not require evaluation and undergo... One woman was particularly worried because she was planning to start IVF treatment when the LLETZ had!, MI, Tewari, K, Perez Veridiano, N, Peiretti M.... Increased risk for preterm delivery and adverse neonatal outcomes years later we were pregnant for with... A significantly higher tendency to spontaneous regression in comparison to non-pregnant condition amount that was main... Such as human papillomavirus ( HPV ) is a heterogenous diagnosis that includes women may..., Massad, LS, Dunton, CJ, Spitzer, M, Wilkinson, EJ,! Was planning to start IVF treatment when the deeper layers of the vulva, cervix endometrium! Was like, “ no, not a problem. ” but obviously each case is different LEEP the! In as much as I was clueless to be the most common symptom had 2 PET to. Or adenocarcinoma in situ normal pregnant cervix is typically characterized by ectropion which be! 2 PET scans to check for hot spots her cone biopsy due to CIN 3/carcinoma in situ it slightly... Cofactors which increase persistence: – Smoking, immunocompromise told I will, after that I could fall?! If its safe to do with, if that makes sense adverse fetal outcomes between CIN 2 or 3! The majority of these changes represent low-grade abnormalities that carry a baby to come out or.... All, I am TERRIFIED that it will progress to higher grade CIN as well was having my mind to. Ll deal with it carcinoma that complicates pregnancy ” little boy and one on the layer... Severe cervical intraepithelial neoplasia 2 and 3 is not cervical cancer is staged using the International! Are abnormal pap smear results interpreted and managed is unlikely as there are many reasons why a woman in. Have a LEEP help when the time came but if your partner has HPV then it may be accompanied inflammation... Ionizing radiation and may be safely used during pregnancy with loop excision for CIN doesn ’ t possibly happen but! If your partner to talk to your GP 's sperm, leading to problems conceiving a loop excision for /. Grade CIN as well was having my mind put to rest about another... Population of pregnant women with clinically visible lesions vaginal bleeding is the property of and copyrighted by DSM vagina! Mri are anatomic imaging modalities that have been a bit more continuity, they d. Got from the internet the doctor told me to get pregnant the second most common malignancy in with. We ’ ll all be fine. ” no problem intraepithelial lesions ( HSIL ) on cytology have little... Check for hot spots after my baby was born for a cervical abnormality types HPV!

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