Obstetric and neonatal outcome after surgical treatment of cervical dysplasia

https://doi.org/10.1016/j.ejogrb.2012.01.019Get rights and content

Abstract

Objectives

Conization is the gold standard today for the management of severe cervical dysplasia. However, with the increasing delay until first pregnancy, obstetric follow-up of patients with a history of conization is a growing concern.

Study design

Retrospective case–control study using data from the electronic database of a university hospital. We compared the obstetric and neonatal outcome of 106 pregnancies delivered after conization with the outcome of 212 pregnancies of patients with no history of conization.

Results

A significant reduction in the mean gestational age at delivery (38.23 ± 2.51 weeks vs. 39.15 ± 1.56 weeks) was observed, together with a higher rate of premature rupture of the membrane (9.4% vs. 1.9%), premature onset of labor (9.4% vs. 2.4%), premature delivery (17% vs. 3.8%) and neonatal hospitalization (17.9% vs. 6.6%) in the group of patients with history of conization. Children born to women who had surgery had a significantly lower birth weight (3146.9 ± 611 g vs. 3347.3 ± 502 g) and size (49.1 ± 2.6 cm vs. 50.0 cm ± 2.2 cm) than those of the control group. Furthermore, these children were more frequently admitted in the neonatal intensive care unit (22.6% vs. 10.4%, p = 0.004).

Conclusions

Conization is an important risk factor for premature birth and women with a history of conization require cautious obstetric management during pregnancy. Anti-HPV vaccination and proactive surveillance of low-grade or moderate dysplasia, instead of immediate surgery, should be encouraged in young patients.

Introduction

Human papillomavirus (HPV) infection is the most common sexually transmitted disease [1]. During their lifetime, more than 75% of sexually active women will contract the virus [2]. There are many different types of HPV, which can be differentiated based on their oncogenic properties, and persistent infection with oncogenic HPV types can cause cervical cancer [3]. HPV types 16 and 18 account for more than 50% of all precancerous lesions of the uterine cervix and more than 70% of all cervical cancers. Factors associated with a persistent infection are cigarette smoking, high parity, simultaneous herpes simplex virus type 2 or Chlamydia trachomatis infection, and immunodeficiency. An association with prolonged oral contraceptive use is still a matter of debate [2]. The time of progression from severe dysplasia to invasive cancer is shorter in women with oncogenic HPV types than in women with no HPV infection. The risk of developing cervical cancer from high-grade dysplasia (CIN3) is estimated at 31% after 30 years [4].

Cervical cancer is the second most common cause of cancer-related death among women worldwide. Eighty percent of these deaths occur in developing countries, with a peak of mortality between 35 and 55 years of age. HPV infection, however, is more frequent in adults younger than age 25 [1]. This can be explained by the greater exposure of the junctional zone and the greater number of sexual partners among this population [5]. Fortunately, this young population is characterized by a high HPV clearance rate, and the infection is usually limited to six to 18 months [6], [7].

In some developed countries, well-organized screening programs and adequate treatments of cervical dysplasia have led to a 10-fold decrease in the incidence and mortality of cervical cancer. Conization, which consists of the more or less extensive resection of the transformation zone according to the procedure used, is the treatment of choice for high-grade cervical lesions, and can be performed with a cold knife, laser or electrosurgical loop.

Severe dysplasia affects mostly women between the ages of 25 and 29 [8]. Since the 1980s, the number of younger girls being treated and the age of first pregnancy have both increased, highlighting the interest in studying the relationship between cervical surgery and obstetric outcome. Leiman, in 1980, was the first to demonstrate the correlation between the mean height of the excised cone and the rate of premature births [9] and other works later confirmed these data [10], [11]. The present study examines the influence of conization on several obstetric and neonatal parameters, comparing a group of patients who underwent surgery to a paired control group.

Section snippets

Materials and methods

This retrospective case–control study was performed using data from the electronic databases of the Gynecopathologic and Obstetrics Departments of Erasme University Hospital, and was approved by the Hospital Ethics Committee. The population of patients who underwent conization between January 1999 and 2008 was cross-checked with the database of the Maternity Department to select patients who delivered in Erasme Hospital after undergoing operations on the uterine cervix (with cold knife, laser

Results

Between January 2000 and December 2010, a total of 106 deliveries of women who underwent surgical conization were recorded in our hospital. This included 88 patients who were operated on between January 1999 and December 2010. In this group of patients, 72 women delivered once, 14 delivered twice and two delivered thrice after surgery. The mean age at the time of conization was 29. The characteristics of the study population are presented in Table 1.

Forty patients (46%) underwent a loop

Comments

A total of 8500 cervical conizations are performed every year in Belgium. The results presented above indicate that there is an impact of cervical conization and increasing time until first pregnancy on neonatal and obstetric outcome.

Kyrgiou et al. have already shown that all cervical resection techniques are associated with obstetric complications [12]. Prematurity is a leading cause of perinatal morbidity and mortality and has an important financial impact. Therefore, it is critical to

Acknowledgement

This work was partly supported by a grant of the belgian Televie.

References (26)

  • J. Marchetta

    An end to conizations

    Gynecol Obstet Fertil

    (2009)
  • S. Franceschi et al.

    Variations in the age-specific curves of human papillomavirus prevalence in women worldwide

    Int J Cancer

    (2006)
  • D.R. Lowy et al.

    Human papillomavirus infection and the primary and secondary prevention of cervical cancer

    Cancer

    (2008)
  • Cited by (0)

    View full text