Pregnancy outcome in patients treated with cervical conization for cervical intraepithelial neoplasia

Andı́a, Daniel; Rosales, Francisco; Villasante, A.; Rivero, B.; Díez, J.; Pérez, Carlos Enrique Tene

doi:10.1016/j.ijgo.2010.10.015

Cited by 42 publications

(20 citation statements)

References 26 publications

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“…Several studies investigating preterm birth in relation to time between treatment and pregnancy have reported higher risk with a shorter interval [22;30;31] as did we, while others did not [6;32;33]. …”

Section: Discussionsupporting

confidence: 60%

Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study

et al. 2017

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ObjectiveTo examine whether surgical procedures involving the uterine cervix were associated with pregnancy outcomes, including preterm birth, low birth weight, cesarean delivery and pregnancy loss.DesignPopulation-based observational study nested in retrospective matched cohortSettingKaiser Permanente Northwest integrated health plan in Oregon/Washington, U.S.A.PopulationFemale health plan members age 14–53 years with documented pregnancies from 1998–2009. Women with prior excisional and ablative cervical surgical procedures (N = 322) were compared to women unexposed to cervical procedures (N = 4,307) and, separately, to those having undergone only diagnostic/biopsy procedures (N = 847).MethodsUsing log-linear regression models, we examined risk of adverse pregnancy outcomes in relation to prior excisional or ablative cervical surgical procedures. We stratified excisional procedures by excision thickness. We evaluated for confounding by age, body mass index, race, smoking history, previous preterm birth, and parity.ResultsWe found a positive association between excisional treatment > = 1.0 cm and the outcomes preterm birth and low birth weight (preterm birth unadjusted risk ratio [RR] = 2.15, 95% confidence interval [CI] 1.16–3.98 for excisions ≥1.0 cm compared to unexposed women), particularly in women who delivered within one year of surgery (RR = 3.26, 95% CI 1.41–7.53). There was no clear association between excisional treatment and cesarean delivery, and treated women did not have a substantially higher risk of dysfunctional labor. Ablative treatment was not associated with low birth weight, preterm birth, or cesarean delivery but was associated with pregnancy loss (RR = 1.43, 95% CI 1.05–1.93 vs. unexposed women). Analyses using the diagnostic procedures comparison group produced similar results.ConclusionWomen with > = 1.0 cm excisional treatment had elevated risk of preterm birth and low birth weight when compared to unexposed women and women with cervical diagnostic procedures. This suggests that increased risk derives from the treatment itself, not from other characteristics. The observed association between pregnancy loss and ablative surgical treatment requires further investigation.

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Section: Discussionsupporting

confidence: 60%

Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study

et al. 2017

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“…While some of the studies have reported an increased risk for preterm birth with a shorter interval (7–9), others have found no such association. (10–12) Himes et al performed a retrospective study examining the effect of time interval from LEEP to pregnancy on spontaneous preterm birth.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies that found a link between preterm birth and short interval from LEEP to pregnancy did not adjust for prior preterm birth, which could have confounded their results. (8–9) In the most recent study that investigated the role of time interval in preterm birth risk, Heinonen et al found no association, a result strengthened by their large numbers and adjusted analysis. (12)…”

Section: Discussionmentioning

confidence: 99%

Interval From Loop Electrosurgical Excision Procedure to Pregnancy and Pregnancy Outcomes

Cahill

Tuuli

Stamilio

et al. 2013

Obstetrics & Gynecology

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Objective Prior studies have shown mixed results for pregnancy outcomes after loop electrosurgical excision procedure (LEEP); however, evidence is lacking regarding the pregnancy outcome of spontaneous abortion with respect to time elapsed from LEEP to pregnancy. We investigated risk of spontaneous abortion and preterm birth as they relate to time elapsed from a LEEP to pregnancy. Methods A 10-year, multicenter cohort study of women who underwent LEEP was performed between 1996–2006. Trained research nurses conducted phone interviews with all patients to complete data extraction unavailable in charts. Median time from LEEP to pregnancy for spontaneous abortion compared with no spontaneous abortion and preterm birth before 34 and before 37 weeks compared with term birth were estimated. Patients with time intervals shorter than 12 months compared with 12 months or longer from LEEP to pregnancy were then compared to identify adjusted odds ratios for spontaneous abortion and preterm birth. Results Five hundred ninety-six patients met inclusion criteria. Median time from LEEP to pregnancy was significantly shorter for women with an spontaneous abortion (20 months, interquartile range 11.2–40.9 vs. 31 months, interquartile range 18.7–51.2, p-value 0.01), but did not differ for women with a term birth compared to preterm birth. Women with a time interval shorter than 12 months compared to 12 months or more had a significantly increased risk for spontaneous abortion (17.9% vs. 4.6%, aOR 5.6, 95%CI 2.5–12.7). No increased risk was identified for preterm birth before 34 or before 37 weeks. Conclusion Women with a shorter time interval from LEEP to pregnancy have an increased risk for spontaneous abortion, but not preterm birth.

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“…11 One potential explanation may be limitations in power. Only 4 papers with a total of 2419 women with dysplasia were included in the analysis comparing PTB after dysplasia and LEEP, 7,9,10,17 yielding only approximately 50% power to detect the 30% increased risk of PTB we observed associated with an excisional procedure compared to dysplasia alone.…”

Section: Ajogorgmentioning

confidence: 99%

“…[1][2][3][4][5][6] Recent studies have raised the question whether it is the excision itself, the underlying dysplasia, or risk factors for dysplasia that are associated with this risk of PTB. [7][8][9][10] Metaanalytic data suggest that women with a prior LEEP have an increased risk of PTB compared to women with no prior dysplasia but a similar risk of PTB compared to women with dysplasia. 11 Prior work also has demonstrated that the cervical shortening in pregnancy associated with an excisional procedure is an independent risk factor for PTB.…”

mentioning

confidence: 99%

The association between cervical dysplasia, a short cervix, and preterm birth

Sakowicz

Grobman

2015

American Journal of Obstetrics and Gynecology

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Pregnancy outcome in patients treated with cervical conization for cervical intraepithelial neoplasia

Cited by 42 publications

References 26 publications

Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study

Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study

Interval From Loop Electrosurgical Excision Procedure to Pregnancy and Pregnancy Outcomes

The association between cervical dysplasia, a short cervix, and preterm birth

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