The effect of cervical loop electrosurgical excision on subsequent pregnancy outcome: North American experience

Ferenczy, Alex; Choukroun, Denis; Falcone, T.; Franco, Eduardo L.

doi:10.1016/0002-9378(95)91487-0

Cited by 60 publications

(29 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The overall obstetric outcomes after electrosurgical excision in our study showed different results from earlier reports by others. [15][16][17] Common conclusions of earlier studies were that the diathermy loop excision does not affect fertility and pregnancy outcome. However, none of these studies seem to have analyzed the overall rates of pregnancy and preterm delivery after conization, even in a single institute.…”

Section: Discussionmentioning

confidence: 99%

The role of prophylactic cerclage in preventing preterm delivery after electrosurgical conization

et al. 2010

View full text Add to dashboard Cite

Objective: To evaluate pregnancy outcomes after electrosurgical conization. Methods: We retrospectively analyzed the outcomes of 56 singleton pregnancies after electrosurgical conization of the uterine cervix. Of the 56 cases, 25 women underwent prophylactic cerclage with McDonald procedure (cerclage group), and 31 were managed expectantly (expectant group). Pregnancy outcomes including rate of preterm delivery were compared, and the effect of potential risk factors such as depth of cone, interval between conization and pregnancy, and cervical length on the risk of preterm delivery was assessed. Results: The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization than those without (32.1% vs. 15.2%, p＜0.001). However, preterm delivery rate was not different between the two groups (expectant group vs. cerclage group; ＜28 week, 6.5% vs. 8.0%, p=1.000; ＜34 week, 19.4% vs. 20.0%, p=1.000; ＜37 week, 29.0% vs. 36.0%, p=0.579). All obstetric and neonatal outcomes were similar in the two groups. Even when we confined the study subjects to 19 women (19/56, 33.9%) with cervical length less than 25 mm, the preterm delivery rate also was not significantly different between the expectant (n=7) and cerclage group (n=12). Finally, the potential risk factors for preterm delivery were not associated with risk of preterm delivery in patients with a history of electrosurgical conization. Conclusion:The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization before pregnancy. However, prophylactic cervical cerclage did not prevent preterm delivery in these patients.

show abstract

Section: Discussionmentioning

confidence: 99%

The role of prophylactic cerclage in preventing preterm delivery after electrosurgical conization

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Despite a measurable shortening of the cervical length, 50 several studies concluded that LLETZ does not appear to appreciably predispose patients to complications in a subsequent pregnancy, including preterm delivery. [51][52][53][54][55] A recent metaanalysis by Kyrgiou et al, 56 however, does provide evidence that LLETZ (and cold-knife conization) does increase the risk of preterm birth, low birthweight infants, and cesarean sections. A recent report by Samson et al 57 demonstrated a significant increase in the risk of delivery before 37 weeks in patients who had a prior loop excision of the cervix.…”

Section: Large Loop Excision Of the Transformation Zone (Lletz)mentioning

confidence: 99%

Cervical neoplasia in pregnancy. Part 1: screening and management of preinvasive disease

Hunter

Monk

Tewari

2008

American Journal of Obstetrics and Gynecology

View full text Add to dashboard Cite

Cervical cancer screening is an essential component of prenatal care. The diagnosis and management of cervical intraepithelial neoplasia (CIN) during pregnancy are challenging, and sufficient information does not exist to allow for a definitive evidence-based approach. The American Society for Colposcopy and Cervical Pathology has recently published guidelines regarding the evaluation of abnormal Papanicolaou tests and the treatment of CIN in this setting. Many techniques traditionally recommended in the evaluation of abnormal cervical cytology and the treatment of CIN in the nonpregnant woman, such as colposcopy, cervical biopsy, and electrosurgical excision, can be applied to the pregnant patient with important exceptions. The vascular cervix associated with the gravid condition and the risk of premature pregnancy loss mandates deviation from existing consensus guidelines in screening for cervical cancer in pregnancy and treating associated CIN. In the present review, current guidelines regarding cervical cancer screening are reviewed, and data from studies of pregnant populations are summarized.

show abstract

“…In the 1990s, conisation was regarded as a small and safe surgical procedure, and several small studies showed no increased risk of preterm delivery. [2][3][4][5][6] However, in 1999 El-Bastawissi was the first to demonstrate an increased risk of preterm delivery after conisation (OR = 1.6), 7 and since then several studies including a Danish study have confirmed these results. 1,[8][9][10][11][12] A single study has also demonstrated an increase in perinatal mortality after one conisation.…”

Section: Introductionmentioning

confidence: 99%

After conisation of the cervix, the perinatal mortality as a result of preterm delivery increases in subsequent pregnancy

Ørtoft¹,

Henriksen

Hansen

et al. 2010

BJOG

122

View full text Add to dashboard Cite

Objective To determine the effects of one or two conisations on preterm delivery and perinatal mortality in subsequent pregnancies.Design A population-based cohort study.Setting Aarhus University Hospital.Population Preterm delivery and mortality rates were evaluated in 721 deliveries after one conisation, and in 37 deliveries after two conisations, and were compared with 390 deliveries after dysplasia and 74 552 deliveries that were not preceded by conisation or dysplasia.Methods Cox regression was used to evaluate preterm delivery rates and perinatal mortality.Main outcome measures Birthweight, gestational age (prior to 28, 32, and 37 weeks of gestation, respectively) and perinatal mortality.Results The risk of preterm delivery was increased after one conisation [adjusted hazard ratios (95% CI): <37 weeks, 2.8 (2.3-3.5); <28 weeks, 4.9 (2.5-9.7)], and was further increased after two conisations [adjusted hazard ratios (95% CI): <37 weeks, 9.9 (6-17); <28 weeks, 9.8 (1.4-70)], compared with no conisation. One conisation was associated with an increased perinatal mortality [<28 weeks, 9.9 (4.0-25)]. All three methods of conisation [large loop excision of the transformation zone, electroknife and cold knife] increased the risk of preterm delivery.Conclusions A single conisation was associated with a 2.8-fold increased risk of perinatal death, most likely because of a 4.9-fold increase in extreme preterm delivery. Only 37 patients had two conisations, and the results showed a ten-fold increase in the risk of preterm delivery.

show abstract

The effect of cervical loop electrosurgical excision on subsequent pregnancy outcome: North American experience

Cited by 60 publications

References 12 publications

The role of prophylactic cerclage in preventing preterm delivery after electrosurgical conization

The role of prophylactic cerclage in preventing preterm delivery after electrosurgical conization

Cervical neoplasia in pregnancy. Part 1: screening and management of preinvasive disease

After conisation of the cervix, the perinatal mortality as a result of preterm delivery increases in subsequent pregnancy

Contact Info

Product

Resources

About