Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease

Kyrgiou, Maria; Athanasiou, Antonios; Kalliala, Ilkka; Paraskevaidi, Maria; Mitra, Anita; Martin-Hirsch, P; Arbyn, Marc; Bennett, Phillip R.; Paraskevaidis, Evangelos

doi:10.1002/14651858.cd012847

Cited by 189 publications

(249 citation statements)

References 150 publications

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“…23,27,28 However, the prevalence of pPROM in our study was low (1.6%) compared with other studies, describing a population incidence of 3%. The association between pPROM and cervical treatment has been described in many studies.…”

Section: P-valuecontrasting

confidence: 74%

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Abnormal cervical cytology is associated with preterm delivery: A population based study

Jar-Allah

Kärrberg

Wiik

et al. 2019

Acta Obstet Gynecol Scand

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Abbreviations: BMI, body mass index; CI, confidence interval; CI, Ncervical intraepithelial neoplasia; pPROM, preterm premature rupture of membranes; RR, relative risk; SG, Asmall-for-gestational-age. AbstractIntroduction: Increasing evidence suggests that cervical intraepithelial neoplasia, with or without subsequent treatment, is associated with preterm delivery. We aimed to explore the association between abnormal cervical cytology of different severity and the subsequent obstetric outcomes such as preterm delivery. Material and methods:The historical register-based cohort study comprised 19 822 women in the Western Region of Sweden who had at least one abnormal cervical cytology from 1978 to 2012 before the age of 45 and a subsequent singleton delivery. The reference group comprised 39 644 women with normal cervical cytology and a subsequent singleton delivery, matched by age and parity. Data were retrieved from the Swedish National Cervical Screening Registry, linked to the Swedish Medical Birth Register and Statistic Sweden. The study outcomes were spontaneous preterm delivery before 37 and 34 weeks, low birthweight (≤2500 g), small-for-gestationalage, preterm premature rupture of membranes and neonatal mortality. Multivariable log binominal regression analyses were applied.Results: Preterm delivery before 37 weeks was more common among women with abnormal cervical cytology compared with reference group: 6% vs 4.5%; adjusted relative risk 1.30 (95% confidence interval 1.21-1.39). High vs low-grade abnormal cervical cytology implied a higher risk: 7% vs 5.8% (P < 0.001). Early preterm delivery before 34 weeks, preterm premature rupture of membranes and low birthweight, but not small-for-gestational-age and neonatal mortality, were significantly more common in women with abnormal cervical cytology compared with the reference group.Conclusions: Abnormal cervical cytology may imply an increased risk of preterm delivery. Further studies are needed to investigate whether that risk is related to treatment. K E Y W O R D Sabnormal cervical cytology, cervical intraepithelial neoplasia, neonatal mortality, pregnancy outcome, preterm delivery, preterm premature rupture of membranes, small-for-gestationalage

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Section: P-valuecontrasting

confidence: 74%

“…23 However, the risk of preterm delivery may not be a consequence of treatment only but rather a product of other confounders present in women with cervical dysplasia. 23 However, the risk of preterm delivery may not be a consequence of treatment only but rather a product of other confounders present in women with cervical dysplasia.…”

Section: Discussionmentioning

confidence: 99%

Abnormal cervical cytology is associated with preterm delivery: A population based study

Jar-Allah

Kärrberg

Wiik

et al. 2019

Acta Obstet Gynecol Scand

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“…Conservative management with active surveillance, instead of immediate local excision, is therefore justified in selected women, especially if further pregnancies are considered and compliance with surveillance is likely to be high (primum non nocere). With increasing maternal age and increasing awareness that local treatment for CIN is associated with increased preterm birth and mid-trimester loss,111213141516 treating only those with disease that has a true progressive potential is of utmost importance. In cases of disease that persists beyond two years, treatment is likely to be warranted.…”

Section: Resultsmentioning

confidence: 99%

“…The progressive potential of CIN3 has been reported to be substantially higher overall at 12%8 and 17% at five years 70. Therefore, the management of HSIL histology as a single entity might prevent more personalised care for those who are young and have lesions that are likely to regress, with substantial adverse reproductive consequences 111213141516…”

Section: Discussionmentioning

confidence: 99%

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Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis

Tainio

Athanasiou

Tikkinen

et al. 2018

BMJ

Self Cite

277

242

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ObjectiveTo estimate the regression, persistence, and progression of untreated cervical intraepithelial neoplasia grade 2 (CIN2) lesions managed conservatively as well as compliance with follow-up protocols.DesignSystematic review and meta-analysis.Data sourcesMedline, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 1 January 1973 to 20 August 2016.Eligibility criteriaStudies reporting on outcomes of histologically confirmed CIN2 in non-pregnant women, managed conservatively for three or more months.Data synthesisTwo reviewers extracted data and assessed risk of bias. Random effects model was used to calculate pooled proportions for each outcome, and heterogeneity was assessed using I2 statistics.Main outcome measuresRates of regression, persistence, or progression of CIN2 and default rates at different follow-up time points (3, 6, 12, 24, 36, and 60 months).Results36 studies that included 3160 women were identified (seven randomised trials, 16 prospective cohorts, and 13 retrospective cohorts; 50% of the studies were at low risk of bias). At 24 months, the pooled rates were 50% (11 studies, 819/1470 women, 95% confidence interval 43% to 57%; I2=77%) for regression, 32% (eight studies, 334/1257 women, 23% to 42%; I2=82%) for persistence, and 18% (nine studies, 282/1445 women, 11% to 27%; I2=90%) for progression. In a subgroup analysis including 1069 women aged less than 30 years, the rates were 60% (four studies, 638/1069 women, 57% to 63%; I2=0%), 23% (two studies, 226/938 women, 20% to 26%; I2=97%), and 11% (three studies, 163/1033 women, 5% to 19%; I2=67%), respectively. The rate of non-compliance (at six to 24 months of follow-up) in prospective studies was around 10%.ConclusionsMost CIN2 lesions, particularly in young women (<30 years), regress spontaneously. Active surveillance, rather than immediate intervention, is therefore justified, especially among young women who are likely to adhere to monitoring.Systematic review registrationPROSPERO 2014: CRD42014014406.

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Comparison of HPV-16 and HPV-18 Genotyping and Cytological Testing as Triage Testing Within Human Papillomavirus–Based Screening in Mexico

et al. 2019

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Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease

Cited by 189 publications

References 150 publications

Abnormal cervical cytology is associated with preterm delivery: A population based study

Abnormal cervical cytology is associated with preterm delivery: A population based study

Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis

Comparison of HPV-16 and HPV-18 Genotyping and Cytological Testing as Triage Testing Within Human Papillomavirus–Based Screening in Mexico

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