Pregnancy outcome after cervical cone excision: a case‐control study

Sjøborg, Katrine Dønvold; Vistad, Ingvild; Myhr, Siv Svennevik; Svenningsen, Rune; Herzog, Christine; Kloster-Jensen, Arild; Nygård, Gunhild; Hole, Sølvi; Tanbo, Tom

doi:10.1080/11038120701208158

Cited by 87 publications

(14 citation statements)

References 37 publications

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“…Women diagnosed with CIN typically have a childbearing age and the median age of these patients has been reported to be from 34 to 40 years in previous studies [6,7,8,9]. However, the median age was 45 years in our study.…”

Section: Discussioncontrasting

confidence: 54%

“…There are concerns about the increased risk of preterm delivery and other adverse pregnancy-related outcomes after a cervical excisional procedure [7,9]. For this reason, it is difficult to decide whether the ‘see-and-treat' strategy is the optimal method of treatment, although the accuracy of colposcopically directed biopsy itself has long been questioned [6].…”

Section: Discussionmentioning

confidence: 99%

“…However, this cervical excisional procedure might increase the risk of obstetric complications [6,7,8,9]. Unlike invasive SCC, precancerous lesions of the uterine cervix are more frequently found in patients before the age of 40.…”

Section: Introductionmentioning

confidence: 99%

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The Overtreatment Risk of See-and-Treat Strategy in Management of Abnormal Cervical Cytology

Kim

Lee

Kang

et al. 2014

Gynecol Obstet Invest

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Background: To evaluate the feasibility of conization without a prior punch biopsy for patients with abnormal cytology. Methods: A retrospective review was performed for 700 patients who underwent conization at a single institution from January 2003 to August 2012. Each of these patients was assigned to one of two groups, either the ‘see-and-treat' group or the ‘three-step' group, depending on whether the patient had undergone a punch biopsy before conization or not. The final histologic results of two groups were compared. Results: The overtreatment risk was higher in the ‘see-and-treat' group in patients with atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion (ASCUS/LSIL) cytology (64.7% in the ‘see-and-treat' group vs. 36.5% in the ‘three-step' group; p = 0.001). There was no significant statistical difference in the rate of cervical dysplasia or invasive carcinoma in patients with high-grade squamous intraepithelial lesion (HSIL) cytology between groups (91.8% in the ‘see-and-treat' group vs. 93.5% in the ‘three-step' group; p = 0.793). Conclusion: The patients with HSIL on cytology can be managed by a ‘see-and-treat' strategy with a low risk of overtreatment. On the other hand, the ‘three-step' management is more appropriate in patients with ASCUS/LSIL cytology.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

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The Overtreatment Risk of See-and-Treat Strategy in Management of Abnormal Cervical Cytology

Kim

Lee

Kang

et al. 2014

Gynecol Obstet Invest

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“…Sadler et al [14] already demonstrated that for excisions of 17 mm or more the risk of pPROM but not of PD was higher (RR 3.6, 95% CI 1.8–7.5), whereas Samson et al and Sjøborg et al, independently from depth of excision, after cervical laser conisation or loop electrosurgical excision procedure found an increased risk of both pPROM and PD [15, 16]. …”

Section: Resultsmentioning

confidence: 99%

Risk of Preterm Delivery Associated with Prior Treatment of Cervical Precancerous Lesion according to the Depth of the Cone

et al. 2013

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The aim of this study was to evaluate the impact of the surgical excisional procedures for cervical intraepithelial neoplasia (CIN) treatment both on subsequent fertility (cervical factor) and pregnancy complication (risk of spontaneous preterm delivery). We retrospectively analyzed 236 fertile women who underwent conization for CIN. We included in the study 47 patients who carried on pregnancy and delivered a viable fetus. Patients were asked about postconization pregnancies, obstetrical outcomes, and a possible diagnosis of secondary infertility caused by cervical stenosis. We evaluated the depth of surgical excision, the timing between cervical conization and subsequent pregnancies, surgical technique, and maternal age at delivery. We recorded 47 deliveries, 10 cases of preterm delivery; 8 of them were spontaneous. The depth of surgical excision showed a statistically significant inverse correlation with gestational age at birth. The risk of spontaneous preterm delivery increased when conization depth exceeded a cut-off value of 1.5 cm. Our data do not demonstrated a relation between conization and infertility due to cervical stenosis.

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“…When a follow-up test for women with negative biopsy has a high PPV for CIN2+, direct treatment is more suitable than re-biopsies for women older than 40 years of age if the triage test is positive. Given the impact of cervical treatment (such as LLETZ or conization) on pregnancy outcomes [19], [20], [35], [37], [39], [40], cervical treatment is more critical for women planning to have children. In addition, if a high-grade lesion is found in a woman above 40 years of age, there is a higher chance that the lesion has been present for a longer period of time, and at higher risk of progression [34], [41].…”

Section: Discussionmentioning

confidence: 99%

HPV E6/E7 mRNA Testing Is More Specific than Cytology in Post-Colposcopy Follow-Up of Women with Negative Cervical Biopsy

et al. 2011

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BackgroundIn Norway, women with negative or low-grade cervical biopsies (normal/CIN1) are followed up after six months in order to decide on further follow-up or recall for screening at three-year intervals. A high specificity and positive predictive value (PPV) of the triage test is important to avoid unnecessary diagnostic and therapeutic procedures whereas a low risk of high-grade disease among triage negative women assures safety.Materials and MethodsAt the University Hospital of North Norway, cytology and the HPV mRNA test PreTect HPV-Proofer, detecting E6/E7 mRNA from HPV types 16, 18, 31, 33 and 45, are used in post-colposcopy follow-up of women with negative or low-grade biopsy. In this study, women with negative biopsy after high grade cytology (ASC-H/HSIL) and/or positive HPV mRNA test in the period 2005–2009 were included (n = 520). Histologically confirmed cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) was used as study endpoint.ResultsOf 520 women with negative or low-grade biopsy, 124 women (23.8%) had CIN2+ in follow-up biopsy. The sensitivity and specificity of the HPV mRNA test were 89.1% (95% CI, 80.1–98.1) and 92.5% (95% CI, 88.2–96.7), respectively. The ratios of sensitivity, specificity and PPV of HPV mRNA testing compared to repeat cytology for finding CIN2+ was 1.05 (95% CI: 0.92–1.21), 1.21 (95% CI: 1.12–1.32), and 1.49 (95% CI: 1.20–1.86), respectively. The PPV of mRNA was 77.3% (95% CI, 59.8–94.8) in women aged 40 or older.ConclusionWomen with negative cervical biopsy require follow-up before resumption of routine screening. Post-colposcopy HPV mRNA testing was as sensitive but more specific than post-colposcopy cytology. In addition, the HPV mRNA test showed higher PPV. A positive mRNA test post-colposcopy could justify treatment in women above 40 years.

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Pregnancy outcome after cervical cone excision: a case‐control study

Abstract: Treatment by CLC and LEEP increases the risk of preterm delivery, low birth weight and pPROM in subsequent pregnancies.

Cited by 87 publications

References 37 publications

The Overtreatment Risk of See-and-Treat Strategy in Management of Abnormal Cervical Cytology

The Overtreatment Risk of See-and-Treat Strategy in Management of Abnormal Cervical Cytology

Risk of Preterm Delivery Associated with Prior Treatment of Cervical Precancerous Lesion according to the Depth of the Cone

HPV E6/E7 mRNA Testing Is More Specific than Cytology in Post-Colposcopy Follow-Up of Women with Negative Cervical Biopsy

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