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O'Neill D, Pounds R, Scully N, Marriott N, Balega J, Ganesan R, Singh K, Yap J. The impact on obstetric outcomes following complete amputation of the cervix uteri in fertility preservation surgery for cervical neoplasm. Eur J Obstet Gynecol Reprod Biol 2021; 260:171-176. [PMID: 33831646 DOI: 10.1016/j.ejogrb.2021.03.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/11/2021] [Accepted: 03/21/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Radical trachelectomy is offered to women with early-stage cervical neoplasia who desire fertility. The presence of isthmic glands within histological specimens suggests complete cervical amputation and as such, we examined if the presence of these glands in surgical specimens adversely affects obstetric outcomes. STUDY DESIGN The study cohort comprises 43 consecutive cases of early-stage cervical neoplasia. The presence of isthmic glands in pathological specimens was correlated with obstetric outcomes. Univariate and multivariate analyses were constructed to identify clinicopathological factors associated with adverse obstetric outcomes. RESULTS 43 patients underwent fertility sparing surgery; radical (30; 69.8 %) or simple trachelectomy (13; 30.2 %). Of these, 26 (60.5 %) had isthmic glands within the surgical specimen. Isthmic gland presence was not influenced by surgery radicality, disease stage, histological diagnosis, or surgical approach. Obstetric outcomes were available for 36 patients, with 27 attempting conception post-trachelectomy and 15 (55.6 %) achieving at least one pregnancy. Of 21 total pregnancies, the miscarriage and live birth rates were 7.4 % and 85.0 %, respectively. The presence of isthmic glands did not influence the overall conception rate, with 53.8 % of women with complete cervical amputation conceiving compared to 57.1 % of those without (p = 0.8632). Complete removal of the cervix did not increase premature deliveries <37 weeks gestation (p = 0.2521). CONCLUSIONS The presence of isthmic glands in trachelectomy specimens provides a reliable surrogate marker for complete cervical amputation. In cases where complete cervical amputation is required to achieve maximum oncological outcomes, patients may be assured that there is little evident impact on fertility and obstetric outcomes.
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Affiliation(s)
- Danielle O'Neill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, United Kingdom
| | - Rachel Pounds
- Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, United Kingdom; Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Niall Scully
- Department of Pathology, Birmingham Women's NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TG, United Kingdom
| | - Natalie Marriott
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Janos Balega
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Raji Ganesan
- Department of Pathology, Birmingham Women's NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TG, United Kingdom
| | - Kavita Singh
- Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom
| | - Jason Yap
- Institute of Cancer and Genomic Sciences, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, United Kingdom; Pan-Birmingham Gynaecological Cancer Centre, City Hospital, Dudley Road, Birmingham, B18 7QH, United Kingdom.
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A new approach to prevent cervical stenosis in postmenopausal women after loop electrosurgical excision procedure: a randomized controlled trial. Sci Rep 2020; 10:8512. [PMID: 32444670 PMCID: PMC7244737 DOI: 10.1038/s41598-020-65170-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/28/2020] [Indexed: 11/23/2022] Open
Abstract
To determine whether regular cervical dilatation is effective for preventing cervical stenosis, and to identify the associated risk factors, in postmenopausal women after LEEP. This was a prospective randomized clinical trial in postmenopausal women who underwent LEEP at our hospital between August 2018 and May 2019. Patients who met the study criteria were randomly allocated to three groups: control group (without any intervention), intervention group A (underwent cervical dilatation at the 3rd, 5th, and 8th week after LEEP) and intervention group B (underwent cervical dilatation at the 4th, 8th, and 12th week after LEEP). A colposcopic follow-up examination was conducted at 6 months after LEEP to determine the incidence of cervical stenosis. A total of 404 postmenopausal women were found to be finally eligible for the study. The rate of cervical stenosis in the control group was significantly higher than that in the intervention group, and the rate in group A was significantly lower than that in group B. We found regular dilatation after LEEP in postmenopausal women can prevent cervical stenosis. Further, the 3rd, 5th, and 8th weeks after LEEP are optimal time points. Finally, LEEP frequency and resection depth are significant risk factors and can be used to screen postmenopausal women at risk for cervical stenosis after LEEP.
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Xie M, Zhang X, Yu M, Wang W, Hua K. Evaluation of the Cervix After Cervical Conization by Transvaginal Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1109-1114. [PMID: 29044684 DOI: 10.1002/jum.14457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/15/2017] [Accepted: 07/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the stiffness of the cervix after the loop electrosurgical excision procedure (LEEP) by transvaginal elastography and its potential ability to predict future pregnancy. METHODS A retrospective study included patients of reproductive age who underwent LEEP for cervical high-grade squamous intraepithelial lesions on the basis of colposcopic findings and who desired fertility. The characteristics on conventional transvaginal ultrasonography and elastography before and 6 months after LEEP were reviewed and analyzed. Each case had a 12-month follow-up, and the information on pregnancy and a cervical cytologic examination was recorded. RESULTS Fifty-three patients who completed the 12-month follow-up were included in the analysis. Thirty-two cases (group 1) were pregnant during the follow-up, and the other 21 (group 2) had pregnancy failure. The cervical lengths of group 1 and 2 as measured by traditional transvaginal ultrasonography were similar before and 6 months after LEEP. The resistive index of group 1 was significantly higher 6 months after LEEP than before LEEP (mean ± SD, 0.88 ± 0.36 versus 0.42 ± 0.22; P = .007). The mean elasticity score for the cervix was statistically significantly lower after LEEP (2.21 ± 0.53) than before (3.46 ± 0.78; P = .001) in group 1. However, in group 2, the mean elasticity scores were similar after LEEP (3.19 ± 0.58) and before (3.25 ± 0.66; P = .75). CONCLUSIONS Our results suggest that elastography was a useful technique for evaluating the stiffness of the cervix after LEEP. Elastography could provide a potential means to predict future pregnancy after LEEP.
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Affiliation(s)
- Meng Xie
- Departments of Ultrasound, Fudan University, Shanghai, China
| | - Xuyin Zhang
- Departments of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Meng Yu
- Departments of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Keqin Hua
- Departments of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
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Chikazawa K, Netsu S, Akashi K, Suzuki Y, Konno R, Motomatsu S. Increase in the cervical length after the loop electrosurgical excision procedure for grade III cervical intraepithelial neoplasia. J OBSTET GYNAECOL 2016; 37:78-81. [PMID: 27924675 DOI: 10.1080/01443615.2016.1225024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aimed to determine whether the cervical length increases over a period of six months, after the loop electrosurgical excision procedure (LEEP) for grade III cervical intraepithelial neoplasia (CIN), and to identify the factors associated with an increase in the cervical length. We retrospectively reviewed the medical records of 183 patients who underwent the LEEP between April 2011 and March 2014, at the Department of Gynaecology, Kyosai Hospital. Transvaginal ultrasonography was performed at two, three and six months after the LEEP, and the mean increase in the cervical length between two and three months, two and six months, and three and six months were 2.07, 5.23 and 2.92 mm, respectively. The increase in the cervical length was not associated with age, gravidity, parity and the width of CIN. In conclusion, the cervical length may increase gradually over a period of six months after the LEEP.
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Affiliation(s)
- Kenro Chikazawa
- a Department of Obstetrics and Gynaecology , Jichi Medical University , Saitama , Japan
| | - Sachiho Netsu
- a Department of Obstetrics and Gynaecology , Jichi Medical University , Saitama , Japan
| | - Keiko Akashi
- a Department of Obstetrics and Gynaecology , Jichi Medical University , Saitama , Japan
| | - Yurina Suzuki
- a Department of Obstetrics and Gynaecology , Jichi Medical University , Saitama , Japan
| | - Ryo Konno
- a Department of Obstetrics and Gynaecology , Jichi Medical University , Saitama , Japan
| | - Shigeru Motomatsu
- b Department of Gynecology , Kyosai Hospital, Saitama , Saitama Prefecture , Japan
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Martyn F, McAuliffe FM, Wingfield M. The role of the cervix in fertility: is it time for a reappraisal? Hum Reprod 2014; 29:2092-8. [PMID: 25069501 DOI: 10.1093/humrep/deu195] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Knowledge regarding the role of the cervix in fertility has expanded considerably over the past 20 years and in this article, we propose that it is now time for its function to be reappraised. First, we review the anatomy of the cervix and the vaginal ecosystem that it inhabits. Then, we examine the physiology and the role of the cervical mucus. The ongoing mystery of the exact mechanism of the sperm-cervical mucus interaction is reviewed and the key players that may unlock this mystery in the future are discussed. The soluble and cellular biomarkers of the lower female genital tract which are slowly being defined by contemporary research are reviewed. Attempts to standardize these markers, in this milieu, are hindered by the changes that may be attributed to endogenous or exogenous factors such as: age, hormonal changes during the menstrual cycle, ectropion, infection, smoking and exposure to semen during sexual intercourse. We review what is known about the immunology of the cervix. With the widespread use of large loop excision of the transformation zone (LLETZ) for treatment of cervical intraepithelial neoplasia, the anatomy of the cervix is changing for many women. While LLETZ surgery has had very positive effects in the fight against cervical cancer, we debate the impact it could have on a woman's fertility.
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Affiliation(s)
- F Martyn
- Merrion Fertility Clinic, National Maternity Hospital, 60 Lower Mount St, Dublin 2, Ireland UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - F M McAuliffe
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
| | - M Wingfield
- Merrion Fertility Clinic, National Maternity Hospital, 60 Lower Mount St, Dublin 2, Ireland UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, University College Dublin, National Maternity Hospital, Dublin 2, Ireland
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Baldauf JJ, Baulon E, Thoma V, Akladios CY. [Prevention of obstetrical complications following LEEP, is it possible?]. ACTA ACUST UNITED AC 2013; 43:19-25. [PMID: 24332739 DOI: 10.1016/j.jgyn.2013.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 07/12/2013] [Accepted: 08/13/2013] [Indexed: 11/17/2022]
Abstract
Recent epidemiological data suggest an increase of the incidence and prevalence of CIN as well as a decrease of the mean age of the patients presenting these lesions. Large loop electrosurgical procedure (LEEP) is the most commonly used treatment method. According to recent studies LEEP provides a 1.4 to 7.0 fold increase of preterm delivery. Cervical cerclage does not show efficiency in reducing this risk, even if cervical shortening is measured by transvaginal ultrasound. Considering histological severity of lesions and the age of patients, number of currently conducted conizations in France could be avoided and so their obstetrical consequences prevented, just because no treatment is necessary or could be done by ablative procedures.
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Affiliation(s)
- J-J Baldauf
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg cedex, France.
| | - E Baulon
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg cedex, France
| | - V Thoma
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg cedex, France
| | - C Y Akladios
- Département de gynécologie-obstétrique, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg cedex, France
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Robert AL, Nicolas F, Lavoué V, Henno S, Mesbah H, Porée P, Levêque J. [Ultrasonographic evaluation of the uterine cervix length remaining after LOOP-excision]. ACTA ACUST UNITED AC 2013; 43:288-93. [PMID: 23623518 DOI: 10.1016/j.jgyn.2013.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 03/06/2013] [Accepted: 03/22/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess whether there is a correlation between the length of a conization specimen and the length of the cervix measured by vaginal ultrasonography after the operation PATIENTS AND METHODS Prospective observational study including patients less than 45 years with measurement of cervical length before and the day of the conization, and measuring the histological length of the specimen. RESULTS Among the 40 patients enrolled, the average ultrasound measurements before conization was 26.9 mm (± 4.9 mm) against 18.1mm (± 4.4mm) after conization with a mean difference of 8.8mm (± 2.4mm) (difference statistically significant P<.0001). The extent of histological specimen was 9 mm (± 2.2mm) on average. A correlation between ultrasound and histological measurements with a correlation coefficient R=0.85 was found statistically significant (P<0.0001). Moreover, the rate of cervix length remove by loop-excision in our series is 33% (± 8.5%). DISCUSSION A good correlation between the measurements of the specimen and the cervical ultrasound length before and after conization was found, as a significant reduction in cervical length after conization. The precise length of the specimen should be known in case of pregnancy and the prevention of prematurity due to conization rests on selected indications and efficient surgical technique.
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Affiliation(s)
- A-L Robert
- Service de gynécologie, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 347, 35203 Rennes cedex 2, France
| | - F Nicolas
- Service de gynécologie, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 347, 35203 Rennes cedex 2, France
| | - V Lavoué
- Service de gynécologie, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 347, 35203 Rennes cedex 2, France
| | - S Henno
- Service d'anatomie et cytologie pathologiques, CHU Pontchaillou, 2, rue Henri-Le Guilloux, 35033 Rennes cedex 9, France
| | - H Mesbah
- Département d'information médicale, CRLCC Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France
| | - P Porée
- Département d'information médicale, CRLCC Eugène-Marquis, avenue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France
| | - J Levêque
- Service de gynécologie, CHU Anne-de-Bretagne, 16, boulevard de Bulgarie, BP 90 347, 35203 Rennes cedex 2, France.
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Pina A, Lavallée S, Ndiaye C, Mayrand MH. Reproductive Impact of Cervical Conization. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-013-0042-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Carcopino X, Maycock JA, Mancini J, Jeffers M, Farrar K, Martin M, Khalid S, Prendiville W. Image assessment of cervical dimensions after LLETZ: a prospective observational study. BJOG 2012; 120:472-8. [DOI: 10.1111/1471-0528.12105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - JA Maycock
- Department of Gynaecology; Colposcopy Clinic; The Adelaide and Meath Hospital; Tallaght; Dublin; Ireland
| | | | - M Jeffers
- Department of Pathology; The Adelaide and Meath Hospital; Tallaght; Dublin; Ireland
| | - K Farrar
- Department of Gynaecology; Colposcopy Clinic; The Adelaide and Meath Hospital; Tallaght; Dublin; Ireland
| | - M Martin
- Department of Gynaecology; Colposcopy Clinic; The Adelaide and Meath Hospital; Tallaght; Dublin; Ireland
| | - S Khalid
- Department of Gynaecology; Colposcopy Clinic; The Adelaide and Meath Hospital; Tallaght; Dublin; Ireland
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Fischer RL, Sveinbjornsson G, Hansen C. Cervical sonography in pregnant women with a prior cone biopsy or loop electrosurgical excision procedure. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:613-617. [PMID: 20503232 DOI: 10.1002/uog.7682] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To determine if pregnant women with a prior cone biopsy or loop electrosurgical excision procedure (LEEP) have a shorter midtrimester cervical length than do matched controls without a history of cervical surgery. METHODS Eighty-five pregnant women with a singleton gestation and previous cone biopsy or LEEP and 85 controls matched by age (± 5 years), race, gestational age (± 2 weeks), and number of prior vaginal deliveries underwent a single transvaginal cervical sonographic scan at 15-22 weeks' gestation. No patient had a cerclage in either group. RESULTS Mean cervical length was significantly shorter in the cone biopsy/LEEP group (3.3 vs. 3.9 cm, P < 0.001), with no significant difference in the proportion of cervical lengths less than 2.5 cm (5.9 vs. 2.4%). Gestational age at delivery was slightly but significantly lower in the cone biopsy/LEEP group (38.1 vs. 39.1 weeks, P = 0.005) than in the control group, with a higher proportion of women delivering late preterm and very preterm in the cone biopsy/LEEP group. However, no woman with a prior cone biopsy/LEEP experienced a midtrimester loss suggestive of cervical insufficiency, and no patient with a cervical length less than 2.5 cm delivered before 34 weeks' gestation. CONCLUSIONS Midtrimester cervical length in women with a previous cone biopsy or LEEP is significantly shorter than in those without prior cervical surgery. Based on the low frequency of a short cervix or midtrimester loss in women with prior excisional surgery, the routine use of midtrimester cervical sonography in such women is not supported.
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Affiliation(s)
- R L Fischer
- Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Cooper University Hospital, Camden, NJ 08103-1489, USA.
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Jakobsson M, Gissler M, Paavonen J, Tapper AM. Loop Electrosurgical Excision Procedure and the Risk for Preterm Birth. Obstet Gynecol 2009; 114:504-510. [DOI: 10.1097/aog.0b013e3181b052de] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Moore K, Cofer A, Elliot L, Lanneau G, Walker J, Gold MA. Adolescent cervical dysplasia: histologic evaluation, treatment, and outcomes. Am J Obstet Gynecol 2007; 197:141.e1-6. [PMID: 17689626 DOI: 10.1016/j.ajog.2007.03.029] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Revised: 12/07/2006] [Accepted: 03/09/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate histologic findings and outcomes among adolescents with cervical dysplasia. STUDY DESIGN Patient charts (2001-2005) were reviewed. Prevalence of cervical intraepithelial neoplasia (CIN) grades 2 and 3 and progression and regression were recorded. RESULTS Five hundred one patients were identified. On biopsy, 324 patients (65%) had CIN 1 or less, and 177 patients (35%) had CIN > or = 2. Twenty-nine percent of the patients with CIN 2 opted for conservative treatment vs excision. Over 18 months, the condition of 65% of the patients regressed; the condition of 20% of the patients was stable, and the condition of 5% of the patients progressed without cancer. Of the patients who underwent excision (follow-up median, 26 months), 84% experienced regression of their condition; the condition of 11% was persistent, and 5% progressed with no cancer. CONCLUSION CIN > or = 2 is present in 35% of our cohort. Most had CIN 2, and most experienced regression. Our observation supports continued vigilance in the evaluation of adolescents but suggests that less intervention for CIN 2 may be acceptable.
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Affiliation(s)
- Kathleen Moore
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Abstract
OBJECTIVE To estimate whether the time interval between cervical conization and subsequent pregnancy is associated with risk of preterm birth. METHODS 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. RESULTS 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. CONCLUSION 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. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Katherine P Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal Fetal Medicine, University of Pittsburgh School of Medicine, 300 Halket Street, Pittsburgh, PA 15213, USA.
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