Cervical cancer; cervical intraepithelial neoplasia (CIN); conisation; arge loop excision of the transformation zone (LLETZ; pregnancy; preterm delivery (PD); small for gestational age (SGA)
Abstract :
[en] Objective To assess the impact of cervical intraepithelial neoplasia (CIN) treatment on the risk of (spontaneous) preterm delivery (PD) and small for gestational age (SGA) at birth. Design A multicentre cohort study. Setting Maternity wards of four academic hospitals in Belgium. Population Ninety-seven exposed pregnant women (with a CIN treatment history) and 194 nonexposed pregnant women (without a history of CIN treatment). Methods A questionnaire and check of obstetrical files included socio-demographic characteristics, risk factors for PD, obstetrical history for all women and characteristics of the CIN treatment for exposed women. Pregnancy outcomes were recorded after delivery. The influence of previous treatment of CIN on pregnancy outcomes, adjusted for confounding variables, was assessed by Cox regression and lifetables (for the outcome gestational age at birth) and by logistic regression (for the outcomes PD and SGA at birth). Main outcome measures Occurrence of PD and SGA at birth. Results Seventy-nine per cent of the women in the database were multiparous; 16.3% of women with a previous excisional treatment spontaneously delivered preterm, compared with 8.1% of unexposed women [odds ratio (OR), 2.19; 95% confidence interval (CI), 0.97-4.99]. When adjusting for confounding factors (ethnicity, HIV status, education, age, smoking and parity), the OR for PD was 2.33 (95% CI, 0.99-5.49). Excisional treatment did not have an impact on SGA at birth (OR, 0.94; 95% CI,0.41-2.15). The depth of the cone was >10 mm in 63.5% of the documented cases. Large cones, more than 10 mm deep, were associated with a significantly increased risk of PD (adjusted OR, 4.55; 95% CI, 1.32-15.65) compared with untreated women, whereas smaller cones (≤10 mm) were not significantly associated with PD (OR, 2.77; 95% CI, 0.28-27.59). The associations seen for PD with respect to the cone size did not hold for SGA at birth. Conclusions There was an increased risk of (spontaneous) PD after excision of CIN, in particular when the cone depth exceeded 10 mm.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Simoens, C
GOFFIN, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > Gynécologie-Obstétrique CHR
Simon, P
Barlow, P
Antoine, J
Foidart, Jean-Michel ; Université de Liège - ULiège > Département des sciences cliniques > Gynécologie - Obstétrique
Arbyn, M.
Language :
English
Title :
Adverse obstetrical outcomes after treatment of precancerous cervical lesions: a Belgian multicentre study.
Publication date :
2012
Journal title :
BJOG: An International Journal of Obstetrics and Gynaecology
Arbyn M, Autier P, Ferlay J,. Burden of cervical cancer in the 27 member states of the European Union: estimates for 2004. Ann Oncol 2007; 18: 1425-7.
Arbyn M, Castellsagué X, de Sanjosé S, Bruni L, Saraiya M, Bray F, et al. Worldwide burden of cervical cancer in 2008. Ann Oncol 2011; 22: 2675-86.
Arbyn M, Rebolj M, de Kok IM, Becker N, O'Reilly M, Andrae B,. The challenges for organising cervical screening programmes in the 15 old member states of the European Union. Eur J Cancer 2009; 45: 2671-8.
Jemal A, Ward E, Thun M,. Declining death rates reflect progress against cancer. PLoS One 2010; 5: e9584.
Jordan J, Martin-Hirsch P, Arbyn M, Schenck U, Baldauf JJ, Anttila A, et al. Management of abnormal cervical cytology. In:, Arbyn M, Anttila A, Jordan J, Ronco G, Schenck U, Segnan N, et al., editors. European Guidelines for Quality Assurance in Cervical Cancer Screening. Luxembourg: Office for Official Publications of the European Communities, 2008, 191-232.
Wright TC Jr, Massad LS, Dunton CJ, Spitzer M, Wilkinson EJ, Solomon D,. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Am J Obstet Gynecol 2007; 197: 346-55. (Pubitemid 47464164)
Paraskevaidis E, Kitchener HC, Miller ID, Mann E, Jandial L, Fisher PM,. A population-based study of microinvasive disease of the cervix-a colposcopic and cytologic analysis. Gynecol Oncol 1992; 45: 9-12.
Arbyn M, Simoens C, Van Oyen H, Foidart J-M, Goffin F, Simon P, et al. Analysis of 13 million individual patient records pertaining to Pap smears, colposcopies, biopsies and surgery on the uterine cervix (Belgium, 1996-2000). Prev Med 2009; 48: 438-43.
Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E,. Obstetric outcomes after conservative treatment for intra-epithelial or early invasive cervical lesions: a systematic review and meta-analysis of the literature. Lancet 2006; 367: 489-98. (Pubitemid 43208905)
Arbyn M, Kyrgiou M, Simoens C, Raifu AO, Koliopoulos G, Martin-Hirsch P, et al. Peri-natal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: a meta-analysis. BMJ 2008; 337: a1284.
Ang C, Mukhopadhyay A, Burnley C, Faulkner K, Cross PA, Martin-Hirsch P, et al. Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome. BJOG 2011; 118: 685-92.
Arbyn M, Sasieni P, Meijer CJLM, Clavel C, Koliopoulos G, Dillner J,. Clinical applications of HPV testing: a summary of meta-analyses. Vaccine 2006; 24: 78-89.
Visser GH, Eilers PH, Elferink-Stinkens PM, Merkus HM, Wit JM,. New Dutch reference curves for birthweight by gestational age. Early Hum Dev 2009; 85: 737-44.
Bruinsma F, Quinn M,. The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis. BJOG 2011; 118: 1031-41.
Noehr B, Jensen A, Frederiksen K, Tabor A, Kjaer SK,. Loop electrosurgical excision of the cervix and subsequent risk for spontaneous preterm delivery: a population-based study of singleton deliveries during a 9-year period. Am J Obstet Gynecol 2009; 201: 33.
Jakobsson M, Gissler M, Paavonen J, Tapper AM,. Loop electrosurgical excision procedure and the risk for preterm birth. Obstet Gynecol 2009; 114: 504-10.
Albrechtsen S, Rasmussen S, Thoresen S, Irgens LM, Iversen OE,. Pregnancy outcome in women before and after cervical conisation: population based cohort study. BMJ 2008; 337: a1343.
Raio L, Ghezzi F, Di Naro E, Gomez R, Luscher KP,. Duration of pregnancy after carbon dioxide laser conization of the cervix: influence of cone height. Obstet Gynecol 1997; 90: 978-82. (Pubitemid 27510141)
Sadler L, Saftlas A, Wang W, Exeter M, Whittaker J, McCowan L,. Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. J Am Med Assoc 2004; 291: 2100-6. (Pubitemid 38580153)
Samson SL, Bentley JR, Fahey TJ, McKay DJ, Gill GH,. The effect of loop electrosurgical excision procedure on future pregnancy outcome. Obstet Gynecol 2005; 105: 325-32. (Pubitemid 40229450)
Nohr B, Tabor A, Frederiksen K, Kjaer SK,. Loop electrosurgical excision of the cervix and the subsequent risk of preterm delivery. Acta Obstet Gynecol Scand 2007; 86: 596-603. (Pubitemid 46676312)
Soutter P, Ghaem-Maghami S,. Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome. BJOG 2011; 118: 1536.
Jeffcoat M, Parry S, Sammel M, Clothier B, Catlin A, Macones G,. Periodontal infection and preterm birth: successful periodontal therapy reduces the risk of preterm birth. BJOG 2011; 118: 250-6.
Cruickshank ME, Flannelly G, Campbell DM, Kitchener HC,. Fertility and pregnancy outcome following large loop excision of the cervical transformation zone. Br J Obstet Gynaecol 1995; 102: 467-70.
Reilly R, Paranjothy S, Beer H, Brooks C, Fielder H, Lyons R,. Birth outcomes following treatment for precancerous changes to the cervix: a population-based record linkage study. BJOG 2012; 119: 236-44.
Noehr B, Jensen A, Frederiksen K, Tabor A, Kjaer SK,. Depth of cervical cone removed by loop electrosurgical excision procedure and subsequent risk of spontaneous preterm delivery. Obstet Gynecol 2009; 114: 1232-8.
Arbyn M, Steben M,. Highlights of the 26th International Papillomavirus Conference and Workshops (Montreal, 3-8 July 2010). Future Oncol 2010; 6: 1711-24.
Arbyn M, Simoens C, Goffin F, Noehr B, Bruinsma F,. Treatment of cervical cancer precursors: influence of age, completeness of excision and cone depth on therapeutic failure, and on adverse obstetric outcomes. BJOG 2011; 118: 1274-5.