The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis

Bruinsma, F; Quinn, Michael

doi:10.1111/j.1471-0528.2011.02944.x

Cited by 201 publications

(168 citation statements)

References 48 publications

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“…Arguably the best available evidence is from three systematic reviews. [2][3][4] Meta-analysis has revealed that excisional methods (LLETZ, cold-knife conisation and laser conisation) were associated with an increased risk of PTL and low birthweight, and that LLETZ was also associated with an increased risk of preterm prelabour rupture of the membranes (PPROM). 2 The large number of linkage studies that followed confirmed the above findings and enabled the assessment of severe outcomes.…”

Section: Introductionmentioning

confidence: 99%

The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy‐related morbidity

Khalid

Dimitriou

Conroy

et al. 2012

BJOG

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Objective The aim of this study was to determine if the individual physical characteristics of the extirpated transformation zone after large loop excision of the transformation zone (LLETZ) might predict the relative risk of adverse obstetric outcome, specifically preterm labour (PTL).Design A retrospective observational study.Setting University teaching hospital in Dublin (Coombe Women & Infants University Hospital, CWIUH).Population Women who had LLETZ treatment for cervical intraepithelial neoplasia (CIN) in the colposcopy service between 1999 and 2002, and who subsequently had a pregnancy at the CWIUH.Methods Case records and histology reports for eligible women were examined. Age, parity, smoking history, pregnancy complications and CIN grade were recorded. Exclusion criteria were age >42 years, previous treatment for CIN, previous premature labour or twin pregnancies. The Student's t-test, Mann-Whitney U-test, analysis of variants (ANOVA) and logistic regression were employed to analyse the data.Main outcome measures Gestational age at birth, PTL (i.e. <37 weeks of gestation) and miscarriage rate (<24 weeks of gestation).Results Out of 1808 women who underwent LLETZ treatment, a total of 353 women were identified who subsequently had a pregnancy at the CWIUH, with 321 being eligible for inclusion in the study. Of these, 76.3% delivered at term, 9.1% delivered at <37 weeks of gestation and 14.6% miscarried at <24 weeks of gestation. There was a three-fold increase in the risk of PTL if the excision volume exceeded 6 cm 3 (RR = 3.00; 95% CI 1.45-5.92), or when the thickness of the excised tissue was greater than 12 mm (RR = 2.98; 95% CI 1.27-7.01). The time interval between LLETZ and pregnancy did not appear to have an effect on PTL rates. We found no association between the grade of CIN and the risk of PTL.Conclusions This study reveals that the thickness and the total volume of the excised transformation zone are associated with an increased risk of PTL. Excisions thicker than 1.2 cm and larger than 6 cm 3 carry a three times greater risk for PTL.Keywords Cervical intraepithelial neoplasia, dimensions, electrosurgical excision, large loop excision of the transformation zone, loop electrosurgical excision procedure, pregnancy outcomes, preterm labour.

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Section: Introductionmentioning

confidence: 99%

The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy‐related morbidity

Khalid

Dimitriou

Conroy

et al. 2012

BJOG

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“…For pregnant women this approach appears particularly important as only treatment of methylation positive lesions is indicated thereby limiting the risk of preterm delivery resulting from treatment. [118][119][120] .…”

Section: Hsa-mir-124-2 Panel Recently Passed the Later Phases Of Biommentioning

confidence: 99%

Clinical implications of (epi)genetic changes in HPV-induced cervical precancerous lesions

et al. 2014

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PrefaceInfection of cervical epithelium with high-risk human papillomavirus (hrHPV) might result in productive or transforming cervical intraepithelial neoplasia (CIN) lesions, the morphology of which can overlap. In transforming CIN lesions aberrations in host cell genes accumulate over time, which is necessary for ultimate progression to cancer. On the basis of (epi)genetic changes, early and advanced transforming CIN lesions can be distinguished. This paves the way for new molecular tools for cervical screening, diagnosis and management of cervical cancer precursor lesions.

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“…Furthermore, conization increases the risk for premature birth and late abortions in subsequent pregnancies [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

HPV mRNA Testing in Triage of Women with ASC-US Cytology May Reduce the Time for CIN2+Diagnosis Compared with Repeat Cytology

Sørbye¹,

Fismen²,

Gutteberg³

et al. 2013

Current Pharmaceutical Design

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The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis

Cited by 201 publications

References 48 publications

The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy‐related morbidity

The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy‐related morbidity

Clinical implications of (epi)genetic changes in HPV-induced cervical precancerous lesions

HPV mRNA Testing in Triage of Women with ASC-US Cytology May Reduce the Time for CIN2+Diagnosis Compared with Repeat Cytology

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