Obstetric outcomes in patients who have undergone excisional treatment for high-grade cervical squamous intra-epithelial neoplasia

Maina, Giovanni; Ribaldone, Raffaella; Danese, Saverio; Lombardo, Valentina; Cavagnetto, Cristina; Plazzotta, Claudio; Surico, Daniela

doi:10.1016/j.ejogrb.2019.02.025

Cited by 23 publications

(31 citation statements)

References 15 publications

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“…Our results confirm this statement as the incidence of conization before gestation was more frequent in the pPROM group. In a recent study by Maina et al the incidence of pPROM among patients with the history of excisional treatment was also increased (13.13% vs 2.71%) [13]. Another analyzed factor was cervical insufficiency in current pregnancy.…”

Section: Discussionmentioning

confidence: 95%

Comparison of maternal characteristics, pregnancy course, and neonatal outcome in preterm births with and without prelabor rupture of membranes

et al. 2020

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Objectives: The aim of this study was to evaluate pregnancy outcome of patients with prelabor rupture of membranes receiving expectant management and giving birth prematurely in comparison to preterm births of patients with intact membranes. Material and methods: It was a retrospective cohort study comparing maternal and neonatal outcome in two groups of preterm births. The first group included 299 consecutive singleton preterm births complicated by prelabor rupture of membranes. The second group consisted of 349 consecutive singleton preterm births without prelabor rupture of membranes. Results: Patients without pPROM underwent Caesarean sections more often than women from the pPROM group (65.3% vs 45.2%; p < 0.001). No statistically significant differences regarding the gestational age during delivery were identified. Lower birth weight was detected in the group with no history of pPROM (p < 0.001). No differences regarding early-onset sepsis were identified and higher percentage of late-onset infections was observed in infants with no history of pPROM (8.9% vs 4.7%; p = 0.04). Pulmonary hypertension was more common in the infants from the pPROM group (4% vs 1.4%; p = 0.049). Neonatal respiratory distress syndrome and respiratory failure were more prevalent in cases of no pPROM history-20% vs 12.7% (p = 0.02) and 40% vs 25.8% (p < 0.001), respectively. Conclusions: Development of multiple complications in preterm neonates may be more associated with the management, gestational age at birth, and birth weight than with the occurrence of preterm prelabor rupture of membranes.

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Section: Discussionmentioning

confidence: 95%

Comparison of maternal characteristics, pregnancy course, and neonatal outcome in preterm births with and without prelabor rupture of membranes

et al. 2020

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“…In fact, the exact pathogenetic link between cervical excisional treatments and risk of prematurity has not yet been fully elucidated. The causes could be mainly explained that removed tissues might signi cantly in uence the restoration of anatomy and function of cervix following surgery and as a result lead to compromise the integrity of the cervical stroma and a lack of effective mechanical support in subsequent pregnancies [3,5,10,23,24] .…”

Section: Discussionmentioning

confidence: 99%

“…As more reproductive women undergoing excision do not nish their family plan, it increases the challenge that cervical lesion is removed effectively with preserving the competence of cervix. Over the recent years, there has been growing concern about the relationship between treatment for cervical diseases and subsequent risk of adverse pregnancy outcomes [3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

The Proportion of Excised Cone Volume for Cervical Lesions is the Best Predictor of Pregnancy Outcomes after Cervical Conization

Wang

Lin

Yang

et al. 2021

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Background: As much more women in the reproductive period are treated with a cervical conization, the risk of subsequent adverse pregnancy outcomes is also increasing. We carried the present study to evaluate whether absolute cone length/volume and the proportions of the cone length/volume correlate to spontaneous abortion (SAB) and spontaneous preterm birth (SPTB) and their predictive values.Methods: The present retrospective observational study included 312 women undergoing cervical conization for cervical lesions at the Affiliated Hospital of Qingdao University during 2012–2019. The information about the pretreatment cervical dimensions and cone size and pregnancy outcomes were collected to assess the correlation between cone parameters and pregnancy outcomes.Results: In the multivariate logistic regression models, the cervical length excised, the cervical volume excised, the proportion of the length excised, and the proportion of the cervical volume excised significantly correlated with SAB and SPTB, respectively (P<0.05). A most significant inverse correlation of the proportion of the cervical volume excised with pregnancy duration emerged (P<0.001, r=-0.220). The area under the curve (AUC) of the proportion of the cervical volume excised was greatest (0.700,95% CI 0.634-0.765). And the risk of SAB and SPTB increased with the proportion of the cervical volume excised increasing (OR 19.704, 95% CI 4.646-83.568). The cutoff point of the proportion of the cervical volume excised was 19.5% (sensitivity 0.635; specificity 0.655). Conclusion: The cone length/volume and the proportions of cervical length/volume excised were associated with increased risks of SAB and SPTB. The proportion of the cervical volume excised is the best predictor for SAB and SPTB after cervical conization. When the proportion of the cervical volume excised is more than 19.5%, women should be informed about their future risk of SAB and SPTB after cervical conization for cervical lesions.

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“…Cervical squamous intraepithelial lesion (SIL) is a potential precancerous lesion [3], with a high morbidity among women, and occurs most commonly during a woman's reproductive years [4]. Currently treatment for cervical squamous intraepithelial lesion relies on cervical excision procedure [4], mainly including loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC), by excising dysplastic cells from cervical tissue [5,6]. This kind of surgery can not only make a damage to the cervical itself, but also affect the structure and function of uterus integrally.…”

Section: Introductionmentioning

confidence: 99%

“…Prior studies showed that the incidence of Caesarean section rates among women with a prior cervical excision procedure varied widely, from 6.4-42.0% [6,[10][11][12][13][14]. Although, most studies demonstrated that a prior cervical excision procedure did not affect Caesarean section rates [10][11][12][13], some proved that Caesarean section rates were signi cant higher [14] or lower [6] among the women with a prior cervical excision procedure. In addition, the incidence of forceps rates among the women with a prior cervical excision procedure has not been calculated yet.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the Impact of Cervical Excision Procedure on Delivery Mode

YUAN

ZHANG

et al. 2020

Preprint

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Background: Many young women with a history of prior cervical excision procedure have reproductive intention. However, the relationship between having a prior cervical excision procedure and delivery mode has not drawn enough attention from physicians. The aim of this study was to observe the delivery mode of women with a prior cervical excision procedure, and analyze the relationship between having a prior cervical excision procedure and delivery mode.Methods: In this retrospective cohort study of nulliparous women with a singleton pregnancy who have given birth at Beijing Obstetrics and Gynecology Hospital, Capital Medical University between May 2016 and April 2018, delivery mode of women with a history of prior cervical excision procedure were compared with those without such a history. Bivariable analysis were performed to identify whether there was a correlation between having a prior cervical excision procedure and delivery mode, and logistic regression were used modeling on cervical excision procedure for delivery mode outcome.Results: (1) The proportion of premature rupture of fetal membrane (38.3% vs 27.0%, p=0.034) , forceps delivery (12.2% vs 5.9%, p=0.043), and Caesarean sections delivery (33.9% vs. 30.2%,p=0.484 ) were higher among women with a prior cervical excision procedure. (2) The main indication for forceps delivery was to shorten the second stage of labor among women with a prior cervical excision procedure, significantly higher (50% vs 7.7%, p=0.033) among women without such a history. There were no differences in indications for Caesarean sections delivery in two groups (p>0.05). (3) The time interval between cervical excision procedure and pregnancy was not associated with delivery mode (p=0.445). (4) By setting spontaneous labor as control, forceps delivery was associated with cervical excision procedure (OR=0.403, 95%CI=0.179-0.906, p=0.028).Conclusions: Our findings revealed a relationship between having a prior cervical excision procedure and delivery mode. Women with a prior cervical excision procedure were at an increased risk of forceps delivery. The time interval between cervical excision procedure and pregnancy did not affect delivery mode.

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Obstetric outcomes in patients who have undergone excisional treatment for high-grade cervical squamous intra-epithelial neoplasia

Cited by 23 publications

References 15 publications

Comparison of maternal characteristics, pregnancy course, and neonatal outcome in preterm births with and without prelabor rupture of membranes

Comparison of maternal characteristics, pregnancy course, and neonatal outcome in preterm births with and without prelabor rupture of membranes

The Proportion of Excised Cone Volume for Cervical Lesions is the Best Predictor of Pregnancy Outcomes after Cervical Conization

Analysis of the Impact of Cervical Excision Procedure on Delivery Mode

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