Length but not transverse diameter of the excision specimen for high-grade cervical intraepithelial neoplasia (CIN 2–3) is a predictor of pregnancy outcome

Abstract

The objective of this study was to analyze the impact of cone characteristics (depth, transverse diameter, and volume) on subsequent pregnancies after the loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN 2-3). Pregnancy outcomes (preterm birth, gestational age at birth, mode of delivery, and birth weight) of 501 women with singleton gestations and no previous preterm birth or history of late miscarriage, who had previously undergone a single LEEP for CIN 2-3, were retrospectively analyzed with respect to length, transverse diameter, and volume of the excision specimen. The overall incidence of preterm birth was 2.4%. The rate of preterm birth in women with length greater than 20 mm or volume greater than 2.5 cm was significantly higher than that in women with length between 15 and 19 mm (15.6 vs. 3.9%, P=0.02) or women with volume between 2.0 and 2.4 cm (5.8 vs. 1.6%, P=0.04). A linear inverse correlation (r=-0.3, P<0.001) between gestational age at birth and length, but not volume (r=0.0, P=0.9) or transverse diameter (r=0.2, P<0.0001), emerged. The mode of delivery was not affected by cone characteristics. Length, but not transverse diameter and volume, of the excised specimen seems to be related to a lower gestational age at birth. When excisions are performed under strict colposcopic guidance, with a correct modulation of cone length, the risk for preterm birth and cesarean delivery in subsequent pregnancies is not increased.

Analysis of the Impact of Cervical Excision Procedure on Delivery Mode

“…We did not nd an association between having a prior cervical excision procedure and Caesarean sections delivery(p = 0.484), similar with vast previous studies [10][11][12][13]. Theoretically, having a prior cervical excision procedure can affect the coordination of uterine contractions, which is more likely to result in dystocia and increases the risk of both forceps delivery and Caesarean sections delivery.…”

“…It happens because cervix is a growing organ [19]; because uterus can repair itself in a short time with abundant vascularity; because during the long period of pregnancy, uterus grows slowly and has enough time to repair itself to suit pregnancy and delivery condition. However, Liverani et al [13] reported that women who became pregnant within 12 months since LEEP showed a signi cantly lower rate of cesarean sections (31.6% vs. 44.3%, P = 0.03) compared with women with a longer time interval from LEEP to pregnancy. Therefore, further study is still needed to increase the sample size, layer the time interval between cervical excision procedure and pregnancy, and observe the delivery mode between different layers of the time interval.…”

“…Prior studies showed that the incidence of Caesarean section rates among women with a prior cervical excision procedure varied widely, from 6.4-42.0% [6,[10][11][12][13][14]. Although, most studies demonstrated that a prior cervical excision procedure did not affect Caesarean section rates [10][11][12][13], some proved that Caesarean section rates were signi cant higher [14] or lower [6] among the women with a prior cervical excision procedure. In addition, the incidence of forceps rates among the women with a prior cervical excision procedure has not been calculated yet.…”

Role of Close Endocervical Margin in Treatment Failure After Cervical Excision for Cervical Intraepithelial Neoplasia: A Retrospective Study

“…Considering this, wider and cylindrical excisions are often necessary for conservative treatment of AIS, whereas the different biological behavior of squamous intraepithelial lesion can allow the execution of smaller excisions, with the need of a reduced disease-free margin. Moreover, the growing evidence about the increased risk of prematurity and perinatal mortality for increasing cone dimensions 7,8 imposes the need to perform smaller excisions in women with childbearing potential in order to reduce the functional impairment of the uterine cervix. Limited dimensions seem also to determine better recovery of cervical dimensions after excisional procedures, probably reducing the risk of subsequent adverse obstetric outcomes.…”

Incisal margin condition after LEEP for cervical intraepithelial neoplasia patients and prognosis

“…This operation has been applied in the treatment of early-stage cervical invasive cancer and CIN in recent years. The pathological incisal margin condition is the important index for CIN development ( 7 ). It has been proven in the clinic ( 8 ) that patients with a positive incisal margin have poor prognosis, and it is a high risky factor for potential residue and relapse of the disease.…”