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Cervical Surgery’s Effect on Delivery Outcome

Surgical treatment of CIN increased the risk for preterm delivery.

Preterm delivery remains one of our biggest obstetric public health problems. To evaluate whether surgical treatment of cervical intraepithelial neoplasia (CIN) is associated with preterm birth, low birth weight, or perinatal mortality, researchers in Finland conducted a register-based retrospective cohort study of more than 8000 singleton births in approximately 26,000 women who had been treated for CIN compared with women without a history of treatment for CIN. Women were treated with conization (>16,000 women), ablation (>9000 women), or other excisional procedures (e.g., cervical amputation; >600 women). Since the introduction of the loop electrosurgical excisional procedure (LEEP), other methods of conization are rarely used in Finland.

All forms of CIN treatment were associated with increased risk for preterm delivery (relative risk, 1.99, 1.60, and 1.97 after conization, ablation, or other treatments, respectively). Adjustment for smoking and maternal age did not affect the results. The risk after conization was highest for extremely (<28 weeks) and very (28–31 weeks) preterm delivery.

Comment: Retrospective studies have generated conflicting data on whether cervical conization affects subsequent delivery outcome. That cervical excisional procedures for CIN increase risk for cervical incompetence is biologically plausible. Although the authors conclude that cervical conization, including LEEP, is associated with preterm labor, how many of the conizations were performed with LEEP is unclear. Cervical lesions have a high regression rate, particularly in young women, and the American College of Obstetricians and Gynecologists recommends avoiding surgical treatment for CIN I and perhaps CIN II lesions in adolescents. However, therapy is recommended for all women with CIN III (Obstet Gynecol 2006; 107:963).

— Ann J. Davis, MD

Published in Journal Watch Women's Health May 10, 2007

Citation(s):

Jakobsson M et al. Preterm delivery after surgical treatment for cervical intraepithelial neoplasia. Obstet Gynecol 2007 Feb; 109:309-13.

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