Patient preparation starts when the patient is informed she has dysplastic cervical cells on colposcopically directed biopsy. Basic education must be given about cervical disease, treatment options, and the LEEP procedure. Patients also find printed material helpful. The patient may be given instructions to premedicate with a non-steroidal anti-inflammatory drug the night before and the morning of the procedure if there are no contraindications.
The optimal timing for the procedure is within seven days of completion of the menstrual period or at least four days in advance of next menstrual period. After cervical LEEP, there may be swelling sufficient to occlude the endocervical canal, and this can lead to hematoculpa with the need to drain the uterus. By avoiding the time of the menstrual period, there is less potential confusion regarding the origin of post-procedure bleeding, and the chance of causing an arc along a blood path is minimized. This timing also minimizes the likelihood that the patient is pregnant.
Patient consent is mandatory, as every management strategy carries with it some element of risk. An informed consent is predicated on the fact that the patient has received sufficient information from the family physician regarding the risks, benefits, and alternatives to the procedure. The patient record should document the clinician's patient education process.
Securing informed consent from a minor is an important task.
Among states and geographic regions there is considerable variation about
such issues as to who constitutes a minor and what parental consent must
be received by the physician before treating a minor. Many states do not
require parental informed consent before providing treatment to a minor
with a sexually transmitted disease. HPV-related infections, such as cervical
dysplasia, fall within the latter guideline. The physician should record
on the minor patient's chart any and all efforts to secure and receive
informed consent.
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