Cervical stenosis following electrosurgical conization

Abstract

CONTEXT AND OBJECTIVE: Cervical stenosis is a postoperative complication of procedures for treating preinvasive lesions of the cervix and takes on particular importance due to the clinical repercussions associated with it. Furthermore, it causes limitations in relation to cytological and colposcopic follow-up. The aim here was to assess the incidence of cervical stenosis among a cohort of patients who underwent electrosurgical conization and to identify possible prognostic factors associated with its occurrence. DESIGN AND SETTING:Retrospective study at Gynecology and Obstetrics Department, Instituto Fernandes Figueira, Rio de Janeiro. METHODS:This was an observational study among a cohort of patients who underwent electrosurgical conization of the uterine cervix. The possible predictive variables were analyzed as bivariate means between the groups with and without stenosis. We also calculated the incidence density rate ratio for cervical stenosis in relation to each possible predictive variable and the respective confi dence intervals (95%). Levels of 5% were considered signifi cant.RESULTS: 274 patients who underwent electrosurgical conization of the uterine cervix with a minimum follow-up period of six months were included. The crude incidence of cervical stenosis was 7.66% and the incidence density was 3.3/1,000 patients-month. CONCLUSIONS:We did not fi nd associations between the variables for stenosis. However, we observed borderline signifi cance levels relating to hemorrhagic complications before and after the operation (p = 0.089).

Risk of Preterm Delivery Associated with Prior Treatment of Cervical Precancerous Lesion according to the Depth of the Cone

“…In two of three cases we could not assess the macroscopic dimensions of cone specimen into histopathology reports, whereas in the remainder case the cone measured 20 mm; Baldauf et al [28] found a cutoff value for increased risk of cervical stenosis after conization of 20 mm (RR 2.96, 95% CI 1.63–5.38) and concluded that cervical stenosis is related to aggressive excision with cold knife and laser conization involving the endocervix. All three patients with secondary cervical stenosis experienced postoperative hemorrhage and need of suturing or cauterization of the surgical wound; Monteiro et al [30] demonstrated that postoperative hemorrhagic complications are associated with cervical stenosis.…”

Sekundäre Amenorrhoe, Schmierblutungen und Schmerzen nach Konisation

“…Eine Zervikalstenose nach Konisation kommt in etwa 7 % der Fälle vor [3,4]. Eine Hämatozervix ist in der Literatur nur in wenigen Fallbeispielen beschrieben [2,5].…”

Treatment of precancerous cervical lesions

“…They are associated with a higher frequency of late miscarriages, preterm deliveries, preterm premature rupture of membranes, low birthweight, increased perinatal mortality, infertility and cervical stenosis [4,5,11,[25][26][27][28][29]. The long-term complications are determined by the depth of excision and age of the patient.…”