Time From Cervical Conization to Pregnancy and Preterm Birth
University of Pittsburgh, Pittsburgh, Pennsylvania, United States Obstetrics and Gynecology
(Impact Factor: 5.18).
03/2007; 109(2 Pt 1):314-9. DOI: 10.1097/01.AOG.0000251497.55065.74
To estimate whether the time interval between cervical conization and subsequent pregnancy is associated with risk of preterm birth.
Our study is a case control study nested in a retrospective cohort. Women who underwent colposcopic biopsy or conization with loop electrosurgical excision procedure, large loop excision of the transformation zone, or cold knife cone and subsequently delivered at our hospital were identified with electronic databases. Variables considered as possible confounders included maternal race, age, marital status, payor status, years of education, self-reported tobacco use, history of preterm delivery, and dimensions of cone specimen.
Conization was not associated with preterm birth or any subtypes of preterm birth. Among women who underwent conization, those with a subsequent preterm birth had a shorter conization-to-pregnancy interval (337 days) than women with a subsequent term birth (581 days) (P=.004). The association between short conization-to-pregnancy interval and preterm birth remained significant when controlling for confounders including race and cone dimensions. The effect of short conization-to-pregnancy interval on subsequent preterm birth was more persistent among African Americans when compared with white women.
Women with a short conization-to-pregnancy interval are at increased risk for preterm birth. Women of reproductive age who must have a conization procedure can be counseled that conceiving within 2 to 3 months of the procedure may be associated with an increased risk of preterm birth.
Available from: Andrea Dall'Asta
- "In our study we found only three cases of PD before 34 weeks, of whom 1 before 32 weeks, therefore we could not demonstrate an increased risk of extremely preterm birth, as reported by Armarnik et al. . We did not find a relation (í µí± > 0.05) between short conization-to-conception interval and preterm birth, although Himes and Simhan  showed that conception within 2-3 months after CIN surgical treatments may be associated with an increased risk of PD. In our study 5 patients (10.6% of all deliveries) who had a term delivery conceived in 2-3 months after the surgical treatment. "
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ABSTRACT: The aim of this study was to evaluate the impact of the surgical excisional procedures for cervical intraepithelial neoplasia (CIN) treatment both on subsequent fertility (cervical factor) and pregnancy complication (risk of spontaneous preterm delivery). We retrospectively analyzed 236 fertile women who underwent conization for CIN. We included in the study 47 patients who carried on pregnancy and delivered a viable fetus. Patients were asked about postconization pregnancies, obstetrical outcomes, and a possible diagnosis of secondary infertility caused by cervical stenosis. We evaluated the depth of surgical excision, the timing between cervical conization and subsequent pregnancies, surgical technique, and maternal age at delivery. We recorded 47 deliveries, 10 cases of preterm delivery; 8 of them were spontaneous. The depth of surgical excision showed a statistically significant inverse correlation with gestational age at birth. The risk of spontaneous preterm delivery increased when conization depth exceeded a cut-off value of 1.5 cm. Our data do not demonstrated a relation between conization and infertility due to cervical stenosis.
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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: To assess obstetrician-gynecologists' knowledge of preterm birth, including prevalence, risk factors, and utility of various tests in predicting increased risk.
A questionnaire was mailed to 1193 members of the American College of Obstetricians and Gynecologists.
The response rate was 59%. The majority of respondents were familiar with basic preterm birth prevalence rates. However, 21% underestimated the proportion of women with presumptive preterm labor in whom preterm birth will not occur. The majority (55%) overestimated the proportion of preterm births accounted for by multiples. Twelve percent indicated bed rest as a proven method for improving newborn outcome. Respondents were fairly accurate as to which factors produce the biggest increased risk of spontaneous preterm labor or rupture of membranes; however, they tended to overestimate the risk associated with smoking, hypertension, and non-gestational diabetes. They tended to underestimate, or were unsure of, the predictive value of positive fetal fibronectin (fFN) test results or short cervical length.
Obstetrician-gynecologists' basic knowledge concerning preterm birth prevalence and risk factors was adequate. However, they tended to overestimate the risk associated with various maternal factors and underestimate the predictive value of various test results.
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