High-grade cervical abnormalities a...

High-grade cervical abnormalities are frequent in young women who could become pregnant. Studies linking laser conization or aperture electrosurgical excision procedure (LEEP) to an increased risk for preterm delivery have been inconclusive. Sadler and colleagues investigated the risk of preterm delivery following to treatment of cervical neoplasia.

The retrospective cohort application of mind included female patients of a large recently made known Zealand hospital that offered centralized colposcopy and obstetric services. The authors assessed patients who, according to the hospital database, gave birth after at least 20 weeks' gestation and had LEEP or laser practices for cervical intraepithelial neoplasia (CIN) before becoming pregnant. The contemplation also included a control assign places to of women who visited the colposcopy clinic yet did not receive treatment. The authors deduceed data on demographics, medical history, cervical cytology and histology, colposcopic findings, and obstetric history and complications. Assessment also included vertical height of excised tissue, treatment method and number of treatments. The data were adjusted to include risk factors for preterm delivery or premature feud of membranes not related to CIN treatment.

The final analysis included 1020 of the 9226 women in the database. About 14 percent (n = 149) had preterm deliveries. Forty-one were caused from iatrogenic reasons, including induction; 41 occurr spontaneously; and 67 were caused by means of premature rupture of membranes (PROM) before 37 weeks' gestation. Total preterm delivery rates for treated patients were 149 percent compared with 122 percent for untreated patients. PROM occurr in 8 percent of treated patients and in 35 percent of untreated patients. Spontaneous preterm labor occurr in 4 percent of treated patients and 35 percent of untreated patients. CIN treatment did not appear to increase risk for total preterm delivery or spontaneous preterm delivery after data were adjusted for outside risk factors. The adjusted relative risk increased for PROM following laser conization and LEEP treatments (27 and 19 percent respectively), nevertheless not following laser ablation. The risk of PROM and preterm delivery increased as the height of tissue remov increased.

The authors bring to an end that there is an increased risk of PROM and preterm delivery, yet not overall preterm deliveries following laser conization or LEEP Although PROM leads to preterm deliveries, these were higher in the untreated cluster after adjustments compared with the treated cluster The authors attribute this incongruity to the higher rate of iatrogenic preterm deliveries in the untreated assemblage The authors suggest careful adherence to CIN management guidelines, avoidance of unnecessary excisions, and appropriate counseling of previously treated women when they become pregnant.

Sadler L et al. Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA May 5 2004;291:2100-6

COPYRIGHT 2005 American Academy of Family Physicians

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