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Previous studies have found a significantly increased risk of preterm delivery and low birth weight after cervical conization. Most of these studies were case-control studies or were small, hampering the ability to detect significant differences between gestational age groups. This population-based cohort study evaluated the adverse consequences of cervical conization on subsequent pregnancies. The investigators linked data from the Medical Birth Registry of Norway and the Cancer Registry of Norway for the years 1967 to 2003 on 15,108 births occurring in women who had previously had cervical conization and 57,136 who subsequently had the procedure. The 2,164,006 births during the study period by women who had never had cervical conization served as controls.The proportion of preterm birth (delivery before 37 weeks of gestation) was 17.2% [95% confidence interval (CI); 16.6%-17.8%] among women who gave birth after cervical conization; 6.7% (95% CI, 6.5%-6.9%) in women who gave birth before cervical conization; and 6.2% (95% CI, 6.2%-6.3%) in women who never had the procedure. The relative risk (RR) of premature delivery after cervical conization compared with women who never had cervical conization increased with decreasing gestational age: RR 2.5 (95% CI, 2.4-2.6) at 33 to 36 weeks; RR 3.4 (95% CI, 3.1-3.7) at 28 to 32 weeks; and RR 4.4 (95% CI, 3.8-5.0) at 24 to 27 weeks. The risk of a late abortion (Ͻ24 weeks of gestation) was higher after cervical conization compared with no conization; the RR was 4.0 with a 95% CI of 3.3 to 4.8. During the study period, the RR of preterm delivery declined, particularly for delivery before 28 weeks of gestation. These findings show that cervical conization increases the risk of preterm delivery in subsequent pregnancies, especially early in pregnancy when the clinical significance is highest. EDITORIAL COMMENT(As one would expect, the data that we have relating ablative and excisional procedures for cervical dysplasia to late abortion and prematurity were not derived from randomized studies. That is to say, reproductive age women with cervical dysplasia deemed to require cervical ablation or excision have not been randomized to therapy or to expectant management for the purposes of evaluating their subsequent preg-nancy performance. Nor has a study been done wherein women have been randomized to different methods of cervical ablation or excision for the purposes of comparing subsequent pregnancy outcomes. Clearly, randomized trials of this nature would be logistically extremely difficult to do, and, in some situations, ethically problematic. But they would be the best way to overcome the major problem in evaluating the OBSTETRICS Volume 64 Number 2 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTPrevious studies have shown that during cesarean section, the concentration of lactate in myometrial capillary blood is higher among women with dysfunctional labor compared with normal labor. Small increases in lactate concentrations have been associated with impairment in the strength an...

We recommend that resuscitation in utero by intrauterine transfusion should be considered before the 33rd week of gestation in cases of severe fetal anemia. In later gestation, urgent cesarean section is required with adequate resuscitation of the newborn.

Minimally invasive procedures and hysteroscopy of organ-transplanted patients provide a safe solution for the treatment of menorrhagia, submucosal myoma and thick endometrium in postmenopausal patients.