The Fertility of Women After Cervical Laser Surgery

Spitzer, Mark; Herman, Jonathan D.; Krumholz, Burton A.; Lesser, Martin

doi:10.1016/0029-7844(95)00237-l

Cited by 26 publications

(19 citation statements)

References 16 publications

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“…Our finding that ablative treatment is associated with an elevated risk of pregnancy loss is in conflict with the one other examination of this association (RR = 0.65, 95% CI 0.39–1.09) and requires confirmation in other studies [41]. Similar to our study, a recent meta-analysis of nine studies [42] reported no overall association between excisional treatment and miscarriage.…”

Section: Discussioncontrasting

confidence: 54%

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: Discussioncontrasting

confidence: 54%

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

et al. 2017

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“…Although large registry-based studies of treatment with mixed modes of conization provide some evidence that cervical treatment is associated with preterm birth, 3,4 studies of cold-knife conization, [5][6][7][8][9][10] laser conization, [11][12][13][14][15] or LEEP [16][17][18][19][20][21] alone have been limited and inconclusive. Most studies were small and lacked the statistical power necessary to detect a doubling of risk.…”

mentioning

confidence: 99%

“…Most studies were small and lacked the statistical power necessary to detect a doubling of risk. [6][7][8][12][13][14][15][16][17]19,21 Only a handful of studies controlled for potentially important confounding by smoking and socioeconomic status, 3,14 analyzed treatment by depth of tissue excised, 11,12,14,22,23 or evaluated risk of preterm delivery by its specific subtypes (ie, medical induction, premature rupture of membranes before 37 weeks' gesta-tion [pPROM], and spontaneous preterm labor), 5,19,24,25 which are likely to be etiologically distinct. 26 It is plausible that cervical excisional or ablative treatments might affect the risk of preterm delivery by reducing the mechanical support provided by a short-ened cervix, by impairing local immunological defense mechanisms by destruction of glandular epithelia, or by altering cervicovaginal bacterial flora.…”

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confidence: 99%

Treatment for Cervical Intraepithelial Neoplasia and Risk of Preterm Delivery

Sadler

Saftlas²,

Wang³

et al. 2004

JAMA

355

186

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Context It is unclear whether treatments for cervical intraepithelial neoplasia (CIN) increase the subsequent risk of preterm delivery. Most studies have lacked sufficient sample size, mixed heterogeneous subtypes of preterm delivery, and failed to control for confounding factors. Objective To determine whether cervical laser and loop electrosurgical excision procedure (LEEP) treatments increase risk of preterm delivery and its subtypes. Design, Setting, and Participants Retrospective cohort study conducted among women evaluated at a colposcopy clinic serving Auckland, New Zealand (1988-2000), comparing delivery outcomes of untreated women (n=426) and those treated (n=652) with laser conization, laser ablation, or LEEP. Record linkage using unique health identifiers identified women who had subsequent deliveries. Main Outcome Measures Total preterm delivery and its subtypes, spontaneous labor and premature rupture of membranes before 37 weeks' gestation (pPROM). Results The overall rate of preterm delivery was 13.8%. The rate of pPROM was 6.2% and the rate of spontaneous preterm delivery was 3.8%. Analyses showed no significant increase in risk of total preterm delivery (adjusted relative risk [aRR], 1.1; 95% confidence interval [CI], 0.8-1.5) or spontaneous preterm delivery (aRR, 1.3; 95% CI, 0.7-2.6) for any treatment. Risk of pPROM was significantly increased following treatment with laser conization (aRR, 2.7; 95% CI, 1.3-5.6) or LEEP (aRR, 1.9; 95% CI, 1.0-3.8), but not laser ablation (aRR, 1.1; 95% CI, 0.5-2.4). Moreover, risk of pPROM and total preterm delivery increased significantly with increasing height of tissue removed from the cervix in conization. Women in the highest tertile of cone height (Ն1.7 cm) had a greater than 3-fold increase in risk of pPROM compared with untreated women (aRR, 3.6; 95% CI, 1.8-7.5). Conclusions LEEP and laser cone treatments were associated with significantly increased risk of pPROM. Careful consideration should be given to treatment of CIN in women of reproductive age, especially when treatment might reasonably be delayed or targeted to high-risk cases.

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“…Long-term complications are fewer after ablative treatments than after excisional procedures. Ablative treatments are not associated with adverse effects on pregnancy outcomes such as miscarriage, preterm labor or with infertility and other adverse events such as cervical stenosis [4,5,10,11]. Women should receive instructions on self-care, symptoms to expect and on follow-up care after completion of ablative treatment.…”

Section: Ablative Treatmentmentioning

confidence: 99%