After conisation of the cervix, the perinatal mortality as a result of preterm delivery increases in subsequent pregnancy

Abstract

Objective To determine the effects of one or two conisations on preterm delivery and perinatal mortality in subsequent pregnancies.Design A population-based cohort study.Setting Aarhus University Hospital.Population Preterm delivery and mortality rates were evaluated in 721 deliveries after one conisation, and in 37 deliveries after two conisations, and were compared with 390 deliveries after dysplasia and 74 552 deliveries that were not preceded by conisation or dysplasia.Methods Cox regression was used to evaluate preterm delivery rates and perinatal mortality.Main outcome measures Birthweight, gestational age (prior to 28, 32, and 37 weeks of gestation, respectively) and perinatal mortality.Results The risk of preterm delivery was increased after one conisation [adjusted hazard ratios (95% CI): <37 weeks, 2.8 (2.3-3.5); <28 weeks, 4.9 (2.5-9.7)], and was further increased after two conisations [adjusted hazard ratios (95% CI): <37 weeks, 9.9 (6-17); <28 weeks, 9.8 (1.4-70)], compared with no conisation. One conisation was associated with an increased perinatal mortality [<28 weeks, 9.9 (4.0-25)]. All three methods of conisation [large loop excision of the transformation zone, electroknife and cold knife] increased the risk of preterm delivery.Conclusions A single conisation was associated with a 2.8-fold increased risk of perinatal death, most likely because of a 4.9-fold increase in extreme preterm delivery. Only 37 patients had two conisations, and the results showed a ten-fold increase in the risk of preterm delivery.

The cost efficiency of HPV vaccines is significantly underestimated due to omission of conisation-associated prematurity with neonatal mortality and morbidity

“…To our knowledge, the data set from Ortoft et al describing the risk of premature delivery in a given week after conization is comparable to the actual situation in Germany regarding the distribution of different conization procedures with over 80% electrosurgical loop conizations and therefore risk of subsequent pregnancy-related morbidity should not differ significantly. 8 Furthermore, it is not possible to determine the costs of NICU and life-long disability exactly as they may vary extremely and the proportion of newborns in a given week developing different grades of disability is not clearly defined. For NICU treatment and prognosis estimation, we used data from a broad review of the literature, the numbers used for further calculations are minimum estimations in our opinion.…”

“…7,8,10 Although tissue sparing treatments like electrosurgical loop conizations (LEEP) are widely used today, the rising neonatal morbidity and mortality have significant implications due to the large number of necessary conizations. 7,8,10,12,30 In the last years, the recently approved two HPV 16/18 vaccines have raised hope among healthcare professionals throughout the world. The vaccines are highly effective when vaccinating young girls prior to sexual intercourse.…”

“…5,6 However, all excisional procedures of cervical tissue are associated with an increased risk of subsequent pregnancy complications like cervical insuffiency, premature rupture of the membranes, premature delivery and low birth weight babyies. [7][8][9][10][11] The relative risk is highest for cold knife conization, but is significantly increased for LEEP, too. 7,8 As the main burden of high grade CIN is allocated in women of fertile age and conization procedures are common, the increased pregnancy risk is of high importance as it leads to significant perinatal morbidity and mortality.…”

“…[7][8][9][10][11] The relative risk is highest for cold knife conization, but is significantly increased for LEEP, too. 7,8 As the main burden of high grade CIN is allocated in women of fertile age and conization procedures are common, the increased pregnancy risk is of high importance as it leads to significant perinatal morbidity and mortality. [7][8][9][10][11][12] Both HPV vaccines have been shown to be safe and highly effective in preventing CIN and cervical cancer from vaccine-HPV types.…”

“…7,8 As the main burden of high grade CIN is allocated in women of fertile age and conization procedures are common, the increased pregnancy risk is of high importance as it leads to significant perinatal morbidity and mortality. [7][8][9][10][11][12] Both HPV vaccines have been shown to be safe and highly effective in preventing CIN and cervical cancer from vaccine-HPV types. [2][3][4] Regarding the reduction of CIN and subsequent cervical surgery, it has to be considered that high-grade CIN caused by other types than the vaccine-types 16 and 18 may be reduced by crossover protection for some HPV types.…”