Objective Assess the progression, persistence, and regression of cervical intraepithelial neoplasia grade 2 (CIN2) after new guidelines on conservative treatment, compared with previous practice. Design Nationwide register‐based cohort study. Setting Denmark. Population Women aged 18–44 years diagnosed with CIN2 on biopsy: 6721 in 2008–2011 and 6399 in 2014–2017. Methods Register data were retrieved from before (2008–2011) and after (2014–2017) the introduction of new guidelines. Histology diagnoses at second visit were used to assess progression (CIN3+), persistence (CIN2), or regression (CIN1/normal). Main outcome measures Proportion of CIN2 by type of management. Relative risk (RR) and corresponding 95% confidence intervals (95% CIs) for progression, persistence, and regression at second visit in 2014–2017, versus 2008–2011. Results The proportion of CIN2 managed conservatively increased from 29.6% in 2008–2011 to 53.3% in 2014–2017 (RR 1.81, 95% CI 1.73–1.89). Time to second visit increased by 2 months. Regression increased from 23.5 to 30.2% (RR 1.29, 95% CI 1.22–1.36), whereas persistence and progression decreased, from 42.6 to 34.9% (RR 0.82, 95% CI 0.78–0.86) and from 28.0 to 22.8% (RR 0.81, 95% CI 0.77–0.86), respectively. In 2008–2011, women managed conservatively had a regression rate of 41.8%, persistence rate of 40.9%, and progression rate of 16.6%. In 2014–2017, these rates were 46.7, 35.5, and 17.1%, respectively. Conclusion After implementation of the new guidelines, conservative management became more frequent, and is now used for more than half of women with CIN2. Lesion regression became more frequent, now experienced by 47% of women managed conservatively. Similar regression rates were seen in women younger and older than 30 years, suggesting that conservative management is justifiable for women of childbearing age. Tweetable abstract In Denmark, more than half of women with CIN2 are managed conservatively, and half of these women experience lesion regression.

TOLAC is an acceptable individualized option for women without major risk factors.

Topics: Systems-based Practice, Obstetric ComplicationsT he choice between trial of labor after cesarean (TOLAC) or an elective repeat cesarean delivery (ERCD) exists for pregnant women with a prior cesarean delivery (CD) who do not have a medical indication for a repeat CD. Several factors should be considered when making this decision: the estimated chance of succeeding with a vaginal birth after cesarean (VBAC), the risk of an adverse neonatal outcome, the possibility of uterine rupture, and the likelihood of maternal complications. The purpose of this study was to compare the incidence of adverse neonatal outcomes after TOLAC and ERCD and to investigate risk factors for emergency cesarean section and uterine rupture when TOLAC is undertaken.Data were assessed from the Aarhus Birth Cohort database from March 2003 to December 2010 and the demographic data of age and prepregnancy body mass index (BMI) were categorized. Women in the TOLAC group were categorized according to mode of delivery. A total of 1783 women were included: 1161 TOLAC and 622 ERCD. Women in the TOLAC group were more likely to not have had any vaginal delivery before cesarean (P < 0.001), to be younger (P = 0.002), have a lower prepregnancy BMI (P < 0.001), and to deliver a child with a higher birthweight (P < 0.001). Those in the TOLAC group who delivered by emergency cesarean were more likely to have their labor induced. Emergency cesarean sections during TOLAC were associated with a history of no prior vaginal delivery, the index cesarean being performed as an emergency CD during labor, maternal age 30 years and older, prepregnancy BMIZ25 kg/m 2 , and birthweight Z4000 g. The risks of uterine rupture, neonatal depression, neonatal intensive care unit (NICU) admission, and maternal hemorrhage Z1000 mL were increased in the TOLAC group. Adverse neonatal outcome occurred in 10% of the TOLAC neonates in mothers without uterine rupture compared to 33% in those mothers who did have uterine rupture [odds ratio (OR), 4.4; 95% confidence interval (CI), 1.9-9.4]. Epidural analgesia was associated with a significantly increased risk of uterine rupture (OR, 2.2; 95% CI, 1.1-4.9). All cases of uterine rupture occurred in women who did not have a previous vaginal delivery (P = 0.03). Oxytocin, induction of labor by double balloon catheter, index emergency cesarean during labor, and a high prepregnancy BMI were all associated with uterine rupture but did not significantly increase risk for TOLAC failure. TOLAC failed in 33%, and the risk of complete uterine rupture after TOLAC was 1.3%.TOLAC is associated with a higher risk of neonatal depression and neonatal intensive care unit NICU admission, but the majority of women deliver vaginally without rupture and without neonatal morbidity associated with cesarean delivery. The authors concluded that it is reasonable to advise women to undertake TOLAC when individual risk factors are also considered. Topic: Obstetric ComplicationsU rinary incontinence (UI) is a highly prevalent and costly condition that affe...

Taking screening prevented cervical cancers into account, the cancer control potential of HPV-vaccination is considerably higher in women than in men. HPV-vaccination could reduce the burden of screening on women and on health care resources.

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