Abstract
Objectives
Conization is the gold standard today for the management of severe cervical dysplasia.
However, with the increasing delay until first pregnancy, obstetric follow-up of patients
with a history of conization is a growing concern.
Study design
Retrospective case–control study using data from the electronic database of a university
hospital. We compared the obstetric and neonatal outcome of 106 pregnancies delivered
after conization with the outcome of 212 pregnancies of patients with no history of
conization.
Results
A significant reduction in the mean gestational age at delivery (38.23 ± 2.51 weeks vs. 39.15 ± 1.56 weeks) was observed, together with a higher rate of premature rupture of the
membrane (9.4% vs. 1.9%), premature onset of labor (9.4% vs. 2.4%), premature delivery (17% vs. 3.8%) and neonatal hospitalization (17.9% vs. 6.6%) in the group of patients with history of conization. Children born to women
who had surgery had a significantly lower birth weight (3146.9 ± 611 g vs. 3347.3 ± 502 g) and size (49.1 ± 2.6 cm vs. 50.0 cm ± 2.2 cm) than those of the control group. Furthermore, these children were more frequently
admitted in the neonatal intensive care unit (22.6% vs. 10.4%, p = 0.004).
Conclusions
Conization is an important risk factor for premature birth and women with a history
of conization require cautious obstetric management during pregnancy. Anti-HPV vaccination
and proactive surveillance of low-grade or moderate dysplasia, instead of immediate
surgery, should be encouraged in young patients.
Abbreviations:
CIN (cervical intraepithelial neoplasia), HPV (human papillomavirus), NICU (neonatal intensive care unit), OR (odds ratio), PROM (premature rupture of membranes), RR (relative risk)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Variations in the age-specific curves of human papillomavirus prevalence in women worldwide.Int J Cancer. 2006; 119: 2677-2684
- Human papillomavirus infection and the primary and secondary prevention of cervical cancer.Cancer. 2008; 113: 1980-1993
- The causal relation between human papillomavirus and cervical cancer.J Clin Pathol. 2002; 55: 244-265
- Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study.Lancet Oncol. 2008; 9: 425-434
- Cervical cancer.Lancet. 2003; 361: 2217-2225
- Cervical HPV infection and neoplasia in a large population-based prospective study: the Manchester cohort.Br J Cancer. 2004; 91: 942-953
- A 2-year prospective study of human papillomavirus persistence among women with a cytological diagnosis of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion.J Infect Dis. 2007; 195: 1582-1589
- Trends in mortality from cervical cancer in the Nordic countries: association with organised screening programmes.Lancet. 1987; 1: 1247-1249
- Pregnancy following conization of the cervix: complications related to cone size.Am J Obstet Gynecol. 1980; 136: 14-18
- Relationships between mechanical properties and extracellular matrix constituents of the cervical stroma during pregnancy.Semin Perinatol. 2009; 33: 300-307
- Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis.BMJ. 2008; 337: a1284
- Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis.Lancet. 2006; 367: 489-498
- Pregnancy outcome after cervical conisation: a retrospective cohort study in the Leuven University Hospital.BJOG. 2010; 117: 268-273
- Treatment for cervical intraepithelial neoplasia and risk of preterm delivery.JAMA. 2004; 291: 2100-2106
- The effect of loop electrosurgical excision procedure on future pregnancy outcome.Obstet Gynecol. 2005; 105: 325-332
- Matrix metalloproteinases in the cervical mucus plug in relation to gestational age, plug compartment, and preterm labor.Reprod Biol Endocrinol. 2010; 8: 113
- Premature labor and intra-amniotic infection. Clinical aspects and role of the cytokines in diagnosis and pathophysiology.Clin Perinatol. 1995; 22: 281-342
- Epidemiology and causes of preterm birth.Lancet. 2008; 371: 75-84
- Precancerous changes in the cervix and risk of subsequent preterm birth.BJOG. 2007; 114: 70-80
- Pregnancy outcome after treatment for cervical intraepithelial neoplasia.Obstet Gynecol. 2009; 114 (Reprod (Paris). November 2010;39(7):520–528): 727-735
- Pregnancy outcome in patients treated with cervical conization for cervical intraepithelial neoplasia.Int J Gynaecol Obstet. 2011; 112: 225-228
- Pregnancy outcome in women before and after cervical conisation: population based cohort study.BMJ. 2008; 337: a1343
- Duration of pregnancy after carbon dioxide laser conization of the cervix: influence of cone height.Obstet Gynecol. 1997; 90: 978-982
- An end to conizations.Gynecol Obstet Fertil. 2009; 37: 213-215
- Pregnancy outcome after cervical conization: risk factors for preterm delivery and the efficacy of prophylactic cerclage.J Gynecol Oncol. 2010; 21: 225-229
- Prophylactic cerclage in pregnancy. Effect in women with a history of conization.J Reprod Med. 1997; 42: 390-392
Article info
Publication history
Published online: February 16, 2012
Accepted:
January 30,
2012
Received in revised form:
January 4,
2012
Received:
October 10,
2011
Identification
Copyright
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
