Delivery outcome after cold-knife conization of the uterine cervix

Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, Graz, Austria.
Gynecologic Oncology (Impact Factor: 3.77). 11/2006; 103(2):604-7. DOI: 10.1016/j.ygyno.2006.04.003
Source: PubMed


To estimate the risk for preterm delivery and obstetric complications in women with prior cold-knife conization.
In a retrospective study, we compared 76 deliveries of 65 women with prior cold-knife conization with the remaining 29,711 singleton deliveries at our institution between 1992 and 2002.
We found significant shorter duration of pregnancies in the conization group. Delivery prior to 37 weeks was found in 22.4% (n = 17) of the conization group and in 6.6% (n = 1961) of the controls (OR = 4.07 [2.22-7.10], P < 0.001). Preterm premature rupture of the membranes was found in 17.1% (n = 13) of the conization group and in 2.6% (n = 775) of the controls (OR = 7.70 [3.87-14.21], P < 0.001). Birth weight less than 2500 g was found in 18.4% (n = 14) of the conization group and in 7.7% (n = 2280) of the controls (OR = 2.72 [1.40-4.92], P = 0.002). Overall, birth weight in the conization group was not significantly lower (median 3147 g vs. 3287 g, P = 0.115). Cervical tears were found more frequently in the conization group (8.8% [n = 6] vs. 1.3% [n = 236], OR = 7.53 [2.63-17.57], P < 0.001). There was no difference in mode of delivery, duration of labor, head circumference, chorioamnionitis and use of oxytocin.
Cold-knife conization is a risk factor for preterm birth and preterm premature rupture of the membranes and seems to be a risk factor for cervical tears.

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    • "Strict selection criteria and a detailed pathological evaluation of the cone specimen will be of paramount importance to avoid recurrences and deaths in these highly curable patients. The obstetrical impact of a large cone will also need to be studied considering that conization alone is associated with a significant increase in preterm delivery and PROM [47] [48]. "
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    ABSTRACT: Excisional procedures, such as loop electrosurgery (LEEP) and cold knife conization, are recommended treatments for cervical intraepithelial dysplasia (CIN). CIN and excisional treatments are associated with an increased risk of preterm delivery and premature rupture of membranes. This association is fairly consistent across studies focusing on cold knife conization, procedures removing deeper tissue specimens, and repeat procedures. Because the association is not as strong or consistent for single, shallow LEEPs, it is possible that the increased risk may be related, at least partly, to other factors (confounding). To prevent complications, treatment guidelines should be strictly followed to minimize overtreatment. General measures to prevent preterm birth, such as screening and treating infections and smoking cessation should be considered. Given the lack of evidence on the impact of progesterone to prevent preterm delivery in this population, further studies will be needed to determine if transvaginal sonographic cervical length measurement should be offered routinely during pregnancy.
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    ABSTRACT: Constant rise of incidence of intraepithelial uterine cervix lesions in young patients implies a larger number of therapeutic surgical procedures. The paper aims to assess the risk of such surgical procedures on later pregnancy and delivery. The paper is a retrospective study performed at the Clinic of Gynecology and Obstetrics in Niš. The study enrolled 30 pregnant women in the experimental group with conization of the uterine cervix in their history, and 90 pregnant women without history data on previously performed conizations. The investigation demonstrated a significantly higher percentage of deliveries before 37 week of gestation in our experimental group – 20% vs 5.5% in the control group. Deliveries in experimental group more commonly started with preterm rupture of membranes (pPROM) – in 13.3% -while the corresponding percentage in control group was only 2.22%. Related to operative completion of delivery with cesarean section, there were no significant differences between the groups (6.6% vs 3.3% in experimental and control group, respectively). There was a statistically significant difference in cervix injury during labour in experimental (10%) compared to control group (1.1%). Uterine cervix conization represents a risk for preterm labour in late pregnancy. In these women, delivery more commonly starts with preterm rupture of membranes and uterine cervix injuries are more common. Therefore, conization should be utilized only if strictly indicated in young patients, and those with conization should be closely monitored.
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