Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis

doi:10.1136/bmj.a1284

Published 18 September 2008, doi:10.1136/bmj.a1284
Cite this as: BMJ 2008;337:a1284

Research

Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis

M Arbyn, head of unit of cancer epidemiology, leader, working package HPV screening¹^,2, M Kyrgiou, assistant³, C Simoens, assistant¹, A O Raifu, assistant¹, G Koliopoulos, senior lecturer⁴, P Martin-Hirsch, consultant gynaecological oncologist³, W Prendiville, associated professor⁵, E Paraskevaidis, head of department⁴

¹ Scientific Institute of Public Health, Brussels, Belgium, ² European Cooperation on Development and Implementation of Cancer Screening and Prevention Guidelines, IARC, Lyon, France, ³ Department of Obstetrics and Gynaecology, Central Lancashire Teaching Hospitals, Preston, Lancashire, ⁴ Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece, ⁵ Department of Obstetrics and Gynaecology, Coombe Women’s Hospital, Dublin, Ireland

Correspondence to: M ArbynMarc.Arbyn{at}iph.fgov.be

Objective To assess the relative risk of perinatal mortality,severe preterm delivery, and low birth weight associated withprevious treatment for precursors of cervical cancer.

Data sources Medline and Embase citation tracking from January1960 to December 2007.

Selection criteria Eligible studies had data on severe pregnancyoutcomes for women with and without previous treatment for cervicalintraepithelial neoplasia. Considered outcomes were perinatalmortality, severe preterm delivery (<32/34 weeks), extremepreterm delivery (<28/30 weeks), and low birth weight (<2000g, <1500 g, and <1000 g). Excisional and ablative treatmentprocedures were distinguished.

Results One prospective cohort and 19 retrospective studieswere retrieved. Cold knife conisation was associated with asignificantly increased risk of perinatal mortality (relativerisk 2.87, 95% confidence interval 1.42 to 5.81) and a significantlyhigher risk of severe preterm delivery (2.78, 1.72 to 4.51),extreme preterm delivery (5.33, 1.63 to 17.40), and low birthweight of <2000 g (2.86, 1.37 to 5.97). Laser conisation,described in only one study, was also followed by a significantlyincreased chance of low birth weight of <2000 g and <1500g. Large loop excision of the transformation zone and ablativetreatment with cryotherapy or laser were not associated witha significantly increased risk of serious adverse pregnancyoutcomes. Ablation by radical diathermy was associated witha significantly higher frequency of perinatal mortality, severeand extreme preterm delivery, and low birth weight below 2000g or 1500 g.

Conclusions In the treatment of cervical intraepithelial neoplasia,cold knife conisation and probably both laser conisation andradical diathermy are associated with an increased risk of subsequentperinatal mortality and other serious pregnancy outcomes, unlikelaser ablation and cryotherapy. Large loop excision of the transformationzone cannot be considered as completely free of adverse outcomes.

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