Cervical dysplasia and pre-term birth in San Juan city hospital: a cohort retrospective study

Obstetrics and Gynecology Residency Program, San Juan City Hospital, Puerto Rico Medical Center, San Juan Puerto Rico.
Boletín de la Asociación Médica de Puerto Rico 07/2013; 105(2):36-8.
Source: PubMed


Cervical dysplasia alters the release of cytokines and inflammatory mediators in pregnant woman with cervical dysplasia. This study evaluates a cohort of pregnant patients screened for cervical dysplasia to determine the relationship between cervical dysplasia and preterm labor (PTL).
Retrospective chart review of pregnant patients screened for cervical dysplasia at the San Juan City Hospital between October 2006 and December 2010. Patients with low or high-grade squamous intraepithelial lesions (LGSIL or HGSIL, respectively) were evaluated with colposcopy. Primary outcome was the event of PTL and the risk factor evaluated was presence of cervical dysplasia.
A total of 2,059 patients were screened for cervical dysplasia and 59 were evaluated with colposcopy due to LGSIL or HGSIL. From those, 29% were negative for intraepithelial lesions and malignancy (NILM), 54% had cervical intraepithelial neoplasia (CIN)-1, 17% where diagnosed as CIN-2/3 where no invasive cervical cancer was identified. In the group of NILM, 24% had PTL compared to 18% in patients who screened negative on initial cytological evaluation. In cases where CIN-1 was confirmed by colposcopy 28% had PTL compared with 40% in patients with CIN-2/3. Other risk factors associated with PTL were not significantly different among the groups.
Cervical dysplasia in pregnancy may represent an increase risk for premature labor.

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    ABSTRACT: Although the association between high-risk human papillomavirus (HPV) infection and cervical dysplasia as well as cervical cancer is well established, studies on the relationship between HPV infection and risk of preterm birth (PTB) have yielded inconclusive and inconsistent results. Therefore, we conducted a meta-analysis to investigate the association between HPV infection and PTB. The electronic database was searched until July 1, 2014. Relevant studies reporting the association between HPV infection and the risk of PTB were included and for further evaluation. Statistical analysis was performed using Revmen 5.3 and Stata 10.0. Six observational cohort studies and 2 case–control studies were included. A significant association between HPV infection and PTB was observed (odds ratio = 2.12, 95% CI 1.51–2.98, P < 0.001, random effect model). Stratification according to diagnostic methods indicated that both positive HPV DNA status and abnormal cervical cytology were associated with increased risk of PTB. Moreover, our data suggested a higher risk of PTB in Caucasian HPV-infected population, while no significant association was observed in the Asian population. Although the causality remains unclear, findings from our meta-analysis indicate that HPV infection might increase the risk of PTB. In the future, prospective cohorts with larger samples sizes are warranted to ascertain the causality and pathophysiological studies are required to explore the possible biological mechanisms involved.
    Journal of Clinical Virology 09/2014; 61(3). DOI:10.1016/j.jcv.2014.09.002 · 3.02 Impact Factor