Obstetric Outcomes After Treatment for Cervical Intraepithelial Neoplasia

Lima, Ana Furtado; Francisco, Carla; Júlio, Catarina; Paula, Tereza; Vitorino, Adelaide; Borrego, Jorge

doi:10.1097/lgt.0b013e31821a6823

Cited by 13 publications

(13 citation statements)

References 6 publications

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“…We identified 406 potentially eligible studies that fulfilled the inclusion criteria of this review. 5 12 13 14 15 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 No unpublished studies were identified. We excluded studies without an untreated reference population, 94 95 96 97 98 99 100 101 …”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies examined the impact of cold knife conisation, 13 28 29 30 32 33 34 37 60 61 62 82 87 89 10 studied laser conisation, 42 46 47 48 49 51 52 56 76 78 one studied needle excision of the transformation zone. 13 34 studied large loop excision of the transformation zone, 13 39 40 41 44 45 50 55 56 57 58 59 60 62 63 65 66 67 68 69 73 74 76 77 78 80 81 82 83 86 87 88 90 91 eight studied laser ablation, 35 38 39 47 49 54 56 62 one studied radical diathermy, 62 two studied cryotherapy, 31 60 16 studied excision not otherwise specified, 5 12 14 15 53 64 …”

Section: Resultsmentioning

confidence: 99%

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Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis

Kyrgiou

Athanasiou

Paraskevaidi

et al. 2016

BMJ

342

294

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Objective To assess the effect of treatment for cervical intraepithelial neoplasia (CIN) on obstetric outcomes and to correlate this with cone depth and comparison group used.Design Systematic review and meta-analysis.Data sources CENTRAL, Medline, Embase from 1948 to April 2016 were searched for studies assessing obstetric outcomes in women with or without previous local cervical treatment.Data extraction and synthesis Independent reviewers extracted the data and performed quality assessment using the Newcastle-Ottawa criteria. Studies were classified according to method and obstetric endpoint. Pooled risk ratios were calculated with a random effect model and inverse variance. Heterogeneity between studies was assessed with I2 statistics.Main outcome measures Obstetric outcomes comprised preterm birth (including spontaneous and threatened), premature rupture of the membranes, chorioamnionitis, mode of delivery, length of labour, induction of delivery, oxytocin use, haemorrhage, analgesia, cervical cerclage, and cervical stenosis. Neonatal outcomes comprised low birth weight, admission to neonatal intensive care, stillbirth, APGAR scores, and perinatal mortality.Results 71 studies were included (6 338 982 participants: 65 082 treated/6 292 563 untreated). Treatment significantly increased the risk of overall (<37 weeks; 10.7% v 5.4%; relative risk 1.78, 95% confidence interval 1.60 to 1.98), severe (<32-34 weeks; 3.5% v 1.4%; 2.40, 1.92 to 2.99), and extreme (<28-30 weeks; 1.0% v 0.3%; 2.54, 1.77 to 3.63) preterm birth. Techniques removing or ablating more tissue were associated with worse outcomes. Relative risks for delivery at <37 weeks were 2.70 (2.14 to 3.40) for cold knife conisation, 2.11 (1.26 to 3.54) for laser conisation, 2.02 (1.60 to 2.55) for excision not otherwise specified, 1.56 (1.36 to 1.79) for large loop excision of the transformation zone, and 1.46 (1.27 to 1.66) for ablation not otherwise specified. Compared with no treatment, the risk of preterm birth was higher in women who had undergone more than one treatment (13.2% v 4.1%; 3.78, 2.65 to 5.39) and with increasing cone depth (≤10-12 mm; 7.1% v 3.4%; 1.54, 1.09 to 2.18; ≥10-12 mm: 9.8% v 3.4%, 1.93, 1.62 to 2.31; ≥15-17 mm: 10.1% v 3.4%; 2.77, 1.95 to 3.93; ≥20 mm: 10.2% v 3.4%; 4.91, 2.06 to 11.68). The choice of comparison group affected the magnitude of effect. This was higher for external comparators, followed by internal comparators, and ultimately women with disease who did not undergo treatment. In women with untreated CIN and in pregnancies before treatment, the risk of preterm birth was higher than the risk in the general population (5.9% v 5.6%; 1.24, 1.14 to 1.35). Spontaneous preterm birth, premature rupture of the membranes, chorioamnionitis, low birth weight, admission to neonatal intensive care, and perinatal mortality were also significantly increased after treatment.Conclusions Women with CIN have a higher baseline risk for prematurity. Excisional and ablative treatment further increases that risk. The frequency and severit...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis

Kyrgiou

Athanasiou

Paraskevaidi

et al. 2016

BMJ

342

294

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“…Thus, there is a high incidence of minor harms 9 and the potential for future early pregnancy loss or premature labour for women in this age group. [23][24][25][26] Our recommendation for women aged 20-24 years not to undergo screening reflects the low incidence of cervical cancer and associated mortality in this age group (from 2002-2006, incidence 1.3 per 100 000 population, mortality 0.2 per 100 000 population [Appendix 4]); the uncertain benefit of screening for women in this age group, either immediately or at older ages; and the higher risk of false-positive test results (and their associated harms) compared with older women. We conclude that the harms of screening for cervical cancer in women aged 20-24 years outweigh any potential benefits, but we have a ssigned a weak recommendation given the uncertainty of the evidence.…”

Section: Box 1: Grading Of Recommendationsmentioning

confidence: 99%

Recommendations on screening for cervical cancer

2013

CMAJ

157

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“…Since 2008, many more studies have looked at the link between cervical conization and neonatal outcomes [36,43,45,47,[49][50][51][52][53]. Most have used comparison groups from the general population [45,47,[49][50][51]. They did not report the type of conization and mostly provided estimates of risk for the different procedures combined [36,45,47,[49][50][51].…”

Section: Neonatal Outcomesmentioning

confidence: 99%

“…Most have used comparison groups from the general population [45,47,[49][50][51]. They did not report the type of conization and mostly provided estimates of risk for the different procedures combined [36,45,47,[49][50][51]. Compared to the general population, women with CIN who underwent treatment, on average, delivered babies with a lower mean birth weight, an increased risk of low birth weight, an increased risk of intensive care unit admission, and mortality, even after controlling for confounding.…”

Section: Neonatal Outcomesmentioning

confidence: 99%

Reproductive Impact of Cervical Conization

Pina

Lavallée

Ndiaye

et al. 2013

Curr Obstet Gynecol Rep

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Excisional procedures, such as loop electrosurgery (LEEP) and cold knife conization, are recommended treatments for cervical intraepithelial dysplasia (CIN). CIN and excisional treatments are associated with an increased risk of preterm delivery and premature rupture of membranes. This association is fairly consistent across studies focusing on cold knife conization, procedures removing deeper tissue specimens, and repeat procedures. Because the association is not as strong or consistent for single, shallow LEEPs, it is possible that the increased risk may be related, at least partly, to other factors (confounding). To prevent complications, treatment guidelines should be strictly followed to minimize overtreatment. General measures to prevent preterm birth, such as screening and treating infections and smoking cessation should be considered. Given the lack of evidence on the impact of progesterone to prevent preterm delivery in this population, further studies will be needed to determine if transvaginal sonographic cervical length measurement should be offered routinely during pregnancy.

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Obstetric Outcomes After Treatment for Cervical Intraepithelial Neoplasia

Cited by 13 publications

References 6 publications

Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis

Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis

Recommendations on screening for cervical cancer

Reproductive Impact of Cervical Conization

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