Proportion of cervical excision for cervical intraepithelial neoplasia as a predictor of pregnancy outcomes

Kyrgiou, Maria; Valasoulis, George; Stasinou, Sofia-Melina; Founta, Christina; Athanasiou, Antonios; Bennett, Phillip R.; Paraskevadis, Evangelos

doi:10.1016/j.ijgo.2014.07.038

Cited by 65 publications

(71 citation statements)

References 26 publications

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“…4,[8][9][10] However, in recent years, some studies have not been able to confirm the association between excisional treatment and increasing risk for preterm delivery. 4,[8][9][10] However, in recent years, some studies have not been able to confirm the association between excisional treatment and increasing risk for preterm delivery.…”

Section: Introductionmentioning

confidence: 99%

“…The widespread use of cervical cancer screening 1,2 and subsequent excisional treatment of cervical intraepithelial neoplasia (CIN) have lowered the incidence of cervical cancer significantly in developed countries over the past 50 years. 3 Excisional treatment for cervical dysplasia has in several studies been found to be associated with an increased risk of preterm delivery 4,5 defined by the World Health Organization as birth before 37 weeks of gestation. Preterm delivery is the main cause of neonatal mortality as well as short-and long-term morbidity.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, different studies have shown a correlation between the excision length (depth) and the risk of spontaneous preterm delivery. 4,[8][9][10] However, in recent years, some studies have not been able to confirm the association between excisional treatment and increasing risk for preterm delivery. 11,12 Other studies have suggested an association between human papillomavirus (HPV) infection and preterm delivery.…”

Section: Introductionmentioning

confidence: 99%

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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: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…The ability of the human cervix to prevent bacteria ascending from the vagina to the uterine cavity depends on several factors, including a mucus plug that provides a negatively-charged platform for interaction with cationic antimicrobial peptides (AMPs) including the Human β-defensins (HBDs) 14,15 . It is not known why certain women develop ascending infection; women who have had previous cervical excisional treatment are associated with an increased risk of preterm birth 16 , but it is likely that an endogenous compromise in cervical mucosal immunity plays a key role in these cases 17 . In support of this, recent evidence has shown an association between PTB and low mid-trimester cervico-vaginal levels of human β-defensin 2 18 .…”

Section: Introductionmentioning

confidence: 99%

Cervical gene delivery of the antimicrobial peptide, Human β-defensin (HBD)-3, in a mouse model of ascending infection-related preterm birth

Suff

Karda

Díaz

et al. 2019

Preprint

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Approximately 40% of preterm births are preceded by microbial invasion of the intrauterine space: ascent from the vagina is the most common pathway. Within the cervical canal, antimicrobial peptides and proteins (AMPs) help to constitute a barrier which prevents ascending infection. We investigated whether expression of the AMP, human β-defensin-3 (HBD3), in the cervical mucosa prevented bacterial ascent from the vagina into the uterine cavity of pregnant mice. An adeno-associated virus vector containing both the HBD3 gene and GFP transgene (AAV8 HBD3.GFP) or control (AAV8 GFP), was administered intravaginally into E13.5 pregnant mice. Ascending infection was induced at E16.5 using bioluminescent E.coli (E.coli K1 A192PP-lux2). Bioluminescence imaging showed bacterial ascent into the uterine cavity, cellular events that led to premature delivery and a reduction in pups born alive, compared with uninfected controls. In addition, a significant reduction in uterine bioluminescence in the AAV8 HBD3.GFP-treated mice was observed 24 hours post-E.coli infection, compared to AAV8 GFP treated mice, signifying reduced bacterial ascent in AAV8 HBD3.GFP-treated mice. There was also an increase in the number of living pups in AAV HBD3.GFP-treated mice. We propose that HBD3 may be considered a possible candidate for augmenting cervical innate immunity to prevent ascending infection-related preterm birth.

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“…Given that the pre-treatment cervix length and dimensions vary amongst women, it is biologically plausible that the proportion (percentage) of the cervix excised may correlate more accurately to the chances of adverse sequelae than the absolute dimensions, and that there may be a cut-off for the proportion of excision that signifies women at risk131415.…”

mentioning

confidence: 99%

Tracking the Impact of Excisional Cervical Treatment on the Cervix using Biospectroscopy

Halliwell

Kyrgiou

Mitra

et al. 2016

Sci Rep

Self Cite

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Local excisional treatment for cervical intra-epithelial neoplasia (CIN) is linked to significant adverse sequelae including preterm birth, with cone depth and radicality of treatment correlating to the frequency and severity of adverse events. Attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy can detect underlying cervical disease more accurately than conventional cytology. The chemical profile of cells pre- and post-treatment may differ as a result of altered biochemical processes due to excision, or treatment of the disease. Since pre-treatment cervical length varies amongst women, the percentage of cervix excised may correlate more accurately to risk than absolute dimensions. We show that treatment for CIN significantly alters the biochemistry of the cervix, compared with women who have not had treatment; this is due to the removal of cervical tissue rather than the removal of the disease. However, the spectra do not seem to correlate to the cone depth or proportion of cervical length excised. Future research should aim to explore the impact of treatment in a larger cohort.

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Proportion of cervical excision for cervical intraepithelial neoplasia as a predictor of pregnancy outcomes

Abstract: The pretreatment cervical dimensions and the proportions of the volume/length excised vary substantially, and the latter correlates with the pregnancy duration. Assessment of the proportion excised might help to stratify women at risk who need intensive surveillance when pregnant.

Cited by 65 publications

References 26 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

Cervical gene delivery of the antimicrobial peptide, Human β-defensin (HBD)-3, in a mouse model of ascending infection-related preterm birth

Tracking the Impact of Excisional Cervical Treatment on the Cervix using Biospectroscopy

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