HPV straim that causes cervical cancer and pregnancy?

tempestxoxo · Feb 3, 2011

Oops! lol I meant STRAIN in the title, not straim

DizzyLizzyNurse · Feb 3, 2011

I had a coworker who had part of her cervix removed d/t cervical cancer. She was on strict bed rest. She said the Dr wanted to sew her cervix shut, but she hadn't been expecting to get pregnant so by the time they knew she was pregnant it was too late so she was on bed rest for 6 months. I don't know much about it, but that's what she said!

Elvish, BSN, DNP, RN, NP · Feb 3, 2011

We have tons and tons of pts with a hx of HPV; most of them are lady partsl deliveries at term. HPV isn't an indication for c/section. Unless there is a hx of extensive cervical surgery (for any reason, not just HPV) there's not really any special precaution to be taken that I'm aware of.

You have an OB rotation with an instructor that doesn't know anything about OB? Am I reading that correctly? :confused:

klone, MSN, RN · Feb 3, 2011

Cryosurgery, LEEP and cone biopsies (all things done for women who have dysplasia caused by HPV) can cause fertility issues, as well as issues with dilatation during labor, due to the scar tissue that forms from the procedures.

tempestxoxo · Feb 3, 2011

We have tons and tons of pts with a hx of HPV; most of them are lady partsl deliveries at term. HPV isn't an indication for c/section. Unless there is a hx of extensive cervical surgery (for any reason, not just HPV) there's not really any special precaution to be taken that I'm aware of.
You have an OB rotation with an instructor that doesn't know anything about OB? Am I reading that correctly?

Yup! My school lost that instructor and could not find a replacement so the nurse we had was a Public Health Nurse and a Med-Surge Nurse...rediculous!

Elvish, BSN, DNP, RN, NP · Feb 3, 2011

Thanks for the clarification, klone. I was just thinking HPV itself (and not being very clear to boot) when I posted the above...not LEEP, cryosurg, etc. Thanks for clearing that part up. :up:

CAT-CNA · Feb 4, 2011

With my last pregnancy I had gone for my pre baby pap and received a letter in the mail saying I had HPV. When I had the baby my after baby pap showed mild cell changes. The next month I had a colposcopy that showed moderate cell changes, the next month I had a LEEP that showed severe cell changes. My point in telling this is that I have the strain that causes cervical cancer and since I had it while I was pregnant I would say that the strain does not prevent you from carrying to term or even getting pregnant since I believe that I had it before I got pregnant with the last baby. I asked my gyno alot of questions relating to the LEEP and he did say that those procedures is what may cause a issue with fertility, not the HPV itself.

ocmama · Feb 4, 2011

Pretty much what klone said. It is my understanding that it is not HPV that is the issue, but the changes that it can cause to the tissues that can be a problem (warts) or the procedures done to treat HPV like LEEP. If a woman has warts on her perineum or her cervix those tissues will not be able to stretch like they are supposed to and could cause problems when trying to deliver a baby as well as a lot of trauma to the woman's body (excessive tearing). Along the same lines the LEEP procedure takes away a portion of the cervix so this could cause problems with dilatation d/t scar tissue and also cause her to be more likely to have an incompetent cervix and require bed rest. However, the LEEP lady could go ahead and deliver lady partslly with no problem if she does not have any signs (i.e. warts) of HPV.

CEG · Feb 5, 2011

There are reported cases of baby getting HPV in the throat following lady partsl delivery. I don't know the exact statistics on that, but very rare. HPV (any strain) is not considered a contraindication to lady partsl delivery, even if there are genital warts present at the time of delivery. The only contraindication would be genital warts so large they obstruct the birth canal or concerns about tissue friability and tearing.

NPinWCH · Feb 9, 2011

There are reported cases of baby getting HPV in the throat following lady partsl delivery. I don't know the exact statistics on that, but very rare. HPV (any strain) is not considered a contraindication to lady partsl delivery, even if there are genital warts present at the time of delivery. The only contraindication would be genital warts so large they obstruct the birth canal or concerns about tissue friability and tearing.

I did find an article that lists the rate of vertical transmission to an infant anywhere between 1:80 to 1:1500. I had a patient with both of the problems you mention. She was admitted to our unit in active labor with no prenatal care and a history of ROM for about 20 hrs. Her delivery was rapid, within an hour of hitting the door, but otherwise it was uneventful. She did however, have probably the worse condyloma I had ever seen. After delivery her repair was almost impossible for the doctor to finish because of the friable tissue and condyloma. He actually had to remove several very large condyloma in order to approximate the perineum. It was horrible.

At delivery the baby did fine, but he returned through the ER 1 1/2 -2 months later in respiratory distress. I was called from L&D to assist with his stabilization as they could not obtain IV access and were having trouble intubating. He was eventually stabilized and transferred to the children's hospital. I asked the pediatrician later how he was, since I knew the parents from L&D. She informed me that he had laryngeal condyloma that caused airway obstruction.

Human papillomavirus, genital warts and vaccination (2009). InnovAiT, Vol. 2, No. 9, pp. 522-529 from http://rcgp-innovait.oxfordjournals.org/content/2/9/522.full.pdf