Pregnancy Outcome After Treatment for Cervical Intraepithelial Neoplasia

Shanbhag, Smruta; Clark, Heather D.; Timmaraju, V; Bhattacharya, Siladitya; Cruickshank, Margaret

doi:10.1097/aog.0b013e3181b5cba3

Cited by 59 publications

(49 citation statements)

References 30 publications

(37 reference statements)

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“…When studies examining preterm birth subtypes; preterm prelabour rupture of membranes (pPROM) and spontaneous preterm birth were analysed, the pattern for spontaneous preterm birth, with a pooled relative risk of 1.99 (95% CI 1.68-2.36), 11,13,26,36,38 was similar to that of all preterm birth using an external comparison group. The estimate for the risk of preterm prelabour rupture of membranes was higher, with a wider confidence interval (pooled RR 3.40, 95% CI 1.63-8.11).…”

Section: Association Of Excisional Methods Of Treatment and Preterm Bmentioning

confidence: 99%

See 1 more Smart Citation

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

Bruinsma

Quinn

2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

198

145

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Background Studies investigating the association between treatment for precancerous changes in the cervix and risk of preterm birth have used a variety of comparison groups.Objectives To investigate whether treatment for precancerous changes in the cervix is associated with preterm birth (<37 weeks) and to examine the impact of the type of comparison group on estimates of risk.Search strategy PubMed, Embase and CENTRAL were searched for studies pubished between 1950 and 2009.Selection criteria Eligible studies were those that reported preterm birth outcomes for excisional and ablative treatments separately and included a comparison group.Data collection and analysis Pooled relative risks (RR) and 95% confidence intervals were computed using a random effects model.Main results Thirty eligible studies were located. Excisional treatment was associated with an increased odds of preterm birth, when compared with an external (RR 2.19, 95% CI 1.93-2.49) or internal (RR 1.96, 95% CI 1.46-2.64) comparison group. In comparison with women who were assessed but not treated, the risk estimate was smaller (RR 1.25, 95% CI 0.98-1.58). Ablative treatment was associated with an increased risk of preterm birth when an external comparison group (RR 1.47, 95% CI 1.24-1.74) but not an internal comparison group (RR 1.24, 95% CI 0.73-2.10) or untreated comparison group (RR 1.03, 95% CI 0.90-1.18) was used.

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Section: Association Of Excisional Methods Of Treatment and Preterm Bmentioning

confidence: 99%

“…4 In addition, a systematic review (without meta-analysis) was published in 2007. 5 A number of large studies [6][7][8][9][10][11][12][13][14] examining this question have been published since the most recent review, 3 making it timely to update the analysis and examine methodological issues that may influence the findings.…”

Section: Introductionmentioning

confidence: 99%

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

Bruinsma

Quinn

2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

198

145

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“…For example, numerous studies have reported that excised cone size [8,13], number of cervical excisions [8], cervical length at 22-24 weeks of gestation [20,24], and the time interval between surgery and pregnancy [25] are factors that might increase the risk of preterm delivery among women who have previously undergone LEEP. Excision treatments of the transition zone depend on the nature and the extent of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…An early report showed that there is an association between cold-knife conization and adverse obstetric outcomes, including preterm delivery [5]. Subsequently, several systematic reviews and large retrospective studies have reported that women who have undergone LEEP have a 1.7-3.7-fold increased risk of preterm delivery, low birth weight, and premature rupture of the membrane compared with untreated women [6][7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcome after loop electrosurgical excision procedure for cervical intraepithelial neoplasia

Frega

Sesti

Sanctis

et al. 2013

Intl J Gynecology & Obste

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This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues.Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. Objective: To determine pregnancy outcomes among women who underwent loop electrosurgical excision procedure (LEEP). Methods: In a case-control study in Italy, 475 pregnant women who underwent LEEP and 441 untreated pregnant women were enrolled between January 2003 and January 2007. Outcome measures were spontaneous abortion, preterm delivery, and at-term delivery rates. Continuous and discrete variables were analyzed via t, χ 2 , and Fisher exact tests. Groups were compared by analysis of variance and Tukey HSD test. Results: The spontaneous abortion rate was 14.5% and 14.1% in the LEEP and untreated groups, respectively. The preterm delivery rate was 6.4% and 5.0% in the LEEP and untreated groups, respectively. The number of women with a cervical length of less than 30 mm was higher in the LEEP group, but this did not influence preterm delivery rate (odds ratio [OR], 1.01; 95% confidence interval [CI], 0.53-1.95). Among women with a cervical length of less than 15 mm, those treated with a wider removal of cervical tissue showed increased risk of preterm delivery (OR, 5.31; 95% CI, 1.01-28.07). Conclusion: The preterm delivery rate was not higher among women who underwent LEEP than among untreated women. Preterm delivery was associated with cone size and cervical length in the second trimester.

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“…Despite the growing body of evidence that tissue excision is associated with preterm labour, some observational studies have suggested an increased risk of preterm birth associated with CIN itself, regardless of treatment. [11][12][13][14] This association has been attributed to the fact that some women are at high risk of both CIN and preterm birth, or that both conditions are mediated by a common process, such as infection. Prospective studies are required to fully assess the relationship between pre-invasive cervical disease, its treatment and obstetric outcomes.…”

mentioning

confidence: 99%

Treatments for precursors of cervical cancer and preterm labour

Stock

Norman

2012

BJOG

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Please cite this paper as: Stock S, Norman J. Treatments for precursors of cervical cancer and preterm labour. BJOG 2012;119:647-649. Women who have treatment for cervical cancer precursors are at an increased risk of preterm birth. It is generally thought that this risk relates to a decrease in the volume of the cervix, as in some studies the risk of preterm labour has been shown to increase with the volume of tissue removed, 1,2 and the number of procedures, 3 suggesting a 'dose response' to tissue removal. In England in 2009-2010 over 23 800 cervical excisional procedures were carried out, the majority being performed in women of childbearing age.4 Around 98% were performed by large loop excision of the transformation zone (LLETZ), which, although lower in risk than knife cone biopsy, 2 is associated with poor pregnancy outcomes, including preterm birth, spontaneous preterm labour, preterm prelabour rupture of membranes, low birthweight and perinatal mortality. 2,3,[5][6][7] Overall, LLETZ is associated with a between two-and ten-fold increased relative risk of preterm delivery, which is similar to the risk of preterm labour in a woman who has had a previous spontaneous preterm delivery.Three articles in this edition of the journal investigate the relationship between LLETZ excision and preterm delivery.8-10 Papoutsis et al. 8 used 3D transvaginal ultrasound to investigate regeneration of the cervix following LLETZ, prospectively recruiting 73 women undergoing LLETZ, and measuring cervical volume both before and 6 months after the procedure. They related cervical regeneration to the volume of tissue removed, and found that the smaller the volume of tissue excised, the greater the regeneration at 6 months. The authors used an arbitrary definition of 'incomplete regeneration', based on a deficit in cervical volume of 25% at 6 months, compared with the pretreatment volume. Removal of more than 11% of pretreatment cervical volume by LLETZ was associated with 'incomplete regeneration'. It is unclear whether this definition of incomplete regeneration has clinical significance in terms of future pregnancy outcome, but these findings support the hypothesis that increased tissue excision compromises cervical integrity.Khalid et al. 9 also provide evidence of an association between tissue excision and preterm birth. They performed a retrospective study of women with a singleton pregnancy following LLETZ, and examined the relationship between volume, length (distance from distal to proximal margin), and thickness (distance from stromal margin to surface) of the tissue removed and the gestational age at delivery. A total of 344 women were eligible for inclusion, and data was available for 321 of these. Greater specimen volume and thickness was associated with preterm birth (later than 24 weeks and less than 37 weeks of gestation). There was a three-fold increase in the risk of preterm delivery if the excision volume exceeded 6 cm 3 (RR 3.00, 95% CI 1.45-5.92), and if the thickness was >12 mm (RR 3.05, 95% CI 1.31-7.08...

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Pregnancy Outcome After Treatment for Cervical Intraepithelial Neoplasia

Abstract: II.

Cited by 59 publications

References 30 publications

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

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

Pregnancy outcome after loop electrosurgical excision procedure for cervical intraepithelial neoplasia

Treatments for precursors of cervical cancer and preterm labour

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