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

Sakowicz, Allie; Grobman, William A.

doi:10.1016/j.ajog.2015.06.036

Cited by 25 publications

(21 citation statements)

References 20 publications

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“…They assessed women who underwent cervical length screening during 18–23 weeks of gestation stratified by no previous dysplasia, dysplasia with excisional procedure, and dysplasia with no procedure. The risk associated with excisional procedure was independent of cervical length shortening . Their result is in line with our findings and supports our finding that the increased risk of PTB is associated with LEEP itself.…”

Section: Discussionsupporting

confidence: 92%

Risk of preterm birth in women with cervical intraepithelial neoplasia grade one: a population‐based cohort study

Heinonen

Gissler

Paavonen

et al. 2017

Acta Obstet Gynecol Scand

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Introduction. In this population-based register study our objective was to explore the association of cervical intraepithelial neoplasia, grade 1 and loop electrosurcigal excision procedure with preterm birth. Material and methods. Our population consisted of 4759 women diagnosed with cervical intraepithelial neoplasia, grade 1 during 1997-2009 and their 3021 subsequent deliveries analyzed by loop electrosurcigal excision procedure and parity. Hospital Discharge Register was used to identify women diagnosed for cervical intraepithelial neoplasia, grade 1 and these data were linked with the Medical Birth Register data. We calculated odds ratios with 95% confidence intervals. Results. Cervical intraepithelial neoplasia, grade 1 patients with loop electrosurcigal excision procedure had 54 (6.7%) subsequent preterm births and the corresponding figure among cervical intraepithelial neoplasia, grade 1 patients without loop electrosurcigal excision procedure was 116 (5.2%). This results in odds ratios 1.31 (95% confidence interval 0.94-1.83). We assessed the risk before and after diagnosis of cervical intraepithelial neoplasia, grade 1 both for patients with loop electrosurcigal excision procedure (odds ratios 1.47, 95% confidence interval 1.05-2.06) and without loop electrosurcigal excision procedure (odds ratios 0.90, 95% confidence interval 0.71-1.13). An increased risk for preterm birth after diagnosis of cervical intraepithelial neoplasia, grade 1 and loop electrosurcigal excision procedure was observed. We also compared both groups to the background population in the Medical Birth Register. For cervical intraepithelial neoplasia, grade 1 patients without loop electrosurcigal excision procedure the risk for preterm birth was not increased (odds ratios 0.95, 95% confidence interval 0.76-1.21) whereas for cervical intraepithelial neoplasia, grade 1 patients treated with loop electrosurcigal excision procedure the risk for preterm birth was increased (odds ratios 1.45, 95% confidence interval 1.02-1.92). Conclusions. Loop electrosurcigal excision procedure itself increases the risk for preterm birth. Cervical intraepithelial neoplasia, grade 1 as such does not increase the risk for preterm birth.

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Section: Discussionsupporting

confidence: 92%

Risk of preterm birth in women with cervical intraepithelial neoplasia grade one: a population‐based cohort study

Heinonen

Gissler

Paavonen

et al. 2017

Acta Obstet Gynecol Scand

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“…1–15 The earlier the diagnosis of a short cervix, the more likely the patient will deliver preterm. 16–33 Compelling evidence supports the view that this condition is syndromic in nature and has multiple etiologies, 13,34–37 such as a decline in progesterone action, 38–48 prior cervical surgery, 49–57 intra-amniotic inflammation and/ or infection, 58–63 and genuine cervical insufficiency. 35,64 Patients with a mid-trimester sonographic short cervix can be offered treatment with vaginal progesterone 65–73 and, for those with a history of preterm birth, a cervical cerclage 74–80 may be placed.…”

Section: | Introductionmentioning

confidence: 94%

The cytokine network in women with an asymptomatic short cervix and the risk of preterm delivery

Tarca

Fitzgerald

Chaemsaithong

et al. 2017

American J Rep Immunol

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ProblemTo characterize the amniotic fluid (AF) inflammatory-related protein (IRP) network in patients with a sonographic short cervix (SCx) and to determine its relation to early preterm delivery (ePTD).Method of studyA retrospective cohort study included women with a SCx (≤25 mm; n=223) who had amniocentesis and were classified according to gestational age (GA) at diagnosis and delivery (ePTD <32 weeks of gestation).Results(i) In women with a SCx ≤ 22 1/7 weeks, the concentration of most IRPs increased as the cervix shortened; those with ePTD had a higher rate of increase in MIP-1α, MCP-1, and IL-6 concentrations than those delivering later; and (ii) the concentration of most IRPs and the correlation between several IRP pairs were higher in the ePTD group than for those delivering later.ConclusionWomen with a SCx at 16–22 1/7 weeks have a unique AF cytokine network that correlates with cervical length at diagnosis and GA at delivery. This network may aid in predicting ePTD.

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“…This interesting and important result is consistent with the clinical data from several previous studies that have shown a positive relationship between cervical tissue excision and risk of spontaneous preterm birth. [2][3][4][5][6] A recent large cohort study by Miller et al 6 investigated whether dysplasia alone or a prior excisional procedure is associated with preterm birth. Of 18,528 women, the frequency of preterm birth in women with prior cervical tissue excision was higher than that in women with a short cervix (<2.5 cm) between 18 and 24 weeks of gestation and a history of cervical dysplasia alone (8.4 vs. 6.4 and 6.5%, respectively; p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

“…1 Although intrauterine infection is mostly studied as a causal factor for preterm labor, partial uterine cervical tissue excision procedures, such as conization, loop electrosurgical excision, and loop electrosurgical excision of the transformation zone, are known to be associated with spontaneous preterm labor. [2][3][4][5][6] The reason for measuring cervical length in the midtrimester of high-risk pregnant women who have undergone cervical tissue excision is based on the theoretical background that a defective cervix may be related to preterm birth. There is an abundance of clinical research data that support the association between cervical tissue excision and preterm birth; [2][3][4][5][6] however, the causal relationship between such variables is controversial.…”

mentioning

confidence: 99%

“…[2][3][4][5][6] The reason for measuring cervical length in the midtrimester of high-risk pregnant women who have undergone cervical tissue excision is based on the theoretical background that a defective cervix may be related to preterm birth. There is an abundance of clinical research data that support the association between cervical tissue excision and preterm birth; [2][3][4][5][6] however, the causal relationship between such variables is controversial. Conner et al 7 have questioned the notion that cervical tissue excision itself is an independent risk factor for spontaneous preterm labor.…”

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confidence: 99%

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Relationship between Partial Uterine Cervical Tissue Excision and Preterm Birth: An Experimental Animal Study

et al. 2017

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Objective To investigate whether the uterine cervix excision is associated with preterm birth in female mice. Study Design Sexually mature female C57BL/6 mice (n = 40) were randomly divided into four groups (A, sham; B, cervical excision; C, lipopolysaccharide, 100 µg intrauterine injection; and D, cervical excision + lipopolysaccharide injection), with 10 mice per group. Three weeks after cervical excision, timed mating was performed. On gestational day 16, lipopolysaccharide was injected between the first and second horns of the right uterus near the cervix. The uterine cervix was obtained after delivery and was histologically analyzed. Results The mean gestational period in group D was significantly lower than those in the other groups (17, 19.5, 19, and 18.2 days in groups D, A, B, and C, respectively; p = 0.034). The cervical length was shorter in the cervical excision groups (p = 0.004). The muscle-to-collagen ratio in the proximal cervix was higher in group D (p = 0.037). Conclusion Prepregnancy cervical excision and subsequent lipopolysaccharide injection showed a high rate of preterm birth, which was higher than the known lipopolysaccharide injection related preterm birth rate. Prepregnancy cervical excision appears to have additive effects with inflammation in inducing preterm birth, which are associated with the relative muscular component amount.

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

Cited by 25 publications

References 20 publications

Risk of preterm birth in women with cervical intraepithelial neoplasia grade one: a population‐based cohort study

Risk of preterm birth in women with cervical intraepithelial neoplasia grade one: a population‐based cohort study

The cytokine network in women with an asymptomatic short cervix and the risk of preterm delivery

Relationship between Partial Uterine Cervical Tissue Excision and Preterm Birth: An Experimental Animal Study

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