Survey: the management of pregnant women with a history of excisional treatment of the uterine cervix for cervical intra-epithelial neoplasia

Abstract

The purpose of this study is to gauge the management of pregnant women with a past history of cervical excisional treatments for cervical intra-epithelial neoplasia (CIN). A postal survey of 120 consultant obstetricians and gynaecologists in the northwest of England was done. The response rate was 41.7%. Thirty-seven respondents (74%) agreed with the evidence that cervical excisional treatment increases the risk of late miscarriage, preterm labour, premature rupture of the membranes and spontaneous rupture of the membranes at term. Thirty-one (62%) think that cervical assessment during pregnancy in women who had excisional treatments is not essential, nevertheless, 72% of the respondents utilise transvaginal ultrasonography alone or in combination with other methods to assess the cervix in these women. Seventeen (34%) assess the cervix monthly and nineteen (38%) carry out variable assessments ranging between once in the first trimester and every 6-8 weeks. Thirty-one (62%) offer cervical cerclage and 28 (56%) will offer it between 13-16 weeks gestation. Twenty-four (48%) would offer preconception transabdominal cervical cerclage to at-risk women. Forty (80%) do not believe that previous excisional treatment will alter the vaginal flora and only eight (16%) perform high vaginal swabs. There is a lack of consensus and consistency in the cervical assessment for the prediction of the risk of preterm birth in women who had cervical excisional treatments for CIN. Transvaginal ultrasonography alone or in combination with other methods is the most favoured technique in cervical assessment. The majority of the respondents offer cervical cerclage. In the presence of evidence that cervical excisional treatment for CIN carries a real risk of pregnancy loss and morbidity, there is a need for an agreed and standardised strategy in cervical assessment and intervention techniques.

Effects of cervical excisional procedures for cervical intraepithelial neoplasia on pregnancy and birth: A literature review

“…It has been proposed that removal of cervical tissue, which contains collagen and elastic fibres, leads to reduced mechanical integrity and support for the cervix (Sadler et al, 2004). An additional theory suggests that the removal of epithelial cells which secrete cervical mucus may reduce or alter local bacterial flora and thereby reduce immunological defences (Basama & Angala, 2010;Sasieni et al, 2016).…”

“…In a British postal survey of 50 obstetricians, 72% responded that they would assess cervical length for pregnant women who had a history of cervical excisional procedures by ultrasound. Routine cervical cerclage would be offered by 62% obstetricians, with 48% offering it pre-conception (Basama & Angala, 2010). One other study followed six participants over a 13-year time frame, three of whom experienced preterm labour and three of whom carried to term-a sample too small to achieve statistical significance (Nam, Kwon, Kim, & Park, 2010).…”