Pregnancy following cervical conization

doi:10.1016/0002-9378(82)90752-9

American Journal of Obstetrics and Gynecology

Volume 142, Issue 5, 1 March 1982, Pages 506-512

https://doi.org/10.1016/0002-9378(82)90752-9 Get rights and content

Abstract

The effect of cone biopsy for cervical intraepithelial neoplasia on subsequent fertility and pregnancy was evaluated for 314 reproductive age women. Excluding patients lost to follow-up and those who had therapeutic hysterectomy, two study groups totaling 166 patients were obtained. The first consisted of 105 patients who did not become pregnant following conization. We found no evidence of secondary infertility caused by cervical conization. The second group of 61 patients achieved 88 pregnancies following conization. Comparison of these pregnancies with the outcome of 106 pregnancies by these same women prior to conization showered no effect of the operation on spontaneous abortions, preterm delivery, or cesarean section rates. The sole sequela of conization was to alter the duration of the first stage of labor.

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Cited by (41)

Cervical conization and the risk of preterm delivery
2011, American Journal of Obstetrics and Gynecology
The current body of literature concerning cervical conization and its effect on subsequent pregnancy outcome is conflicting. Depending on the type of conization procedure that is examined and the quality of the control group, the results and conclusions vary widely. Because treatment for cervical intraepithelial neoplasia is commonplace among women of reproductive age, it is imperative that practitioners have an understanding of the issues surrounding the treatment. Therefore, this review will summarize the published literature that addresses excisional procedures of the uterine cervix and the risk of preterm delivery in subsequent pregnancies and provide reasonable treatment recommendations for women with cervical abnormalities and a desire for future fertility.
Delivery outcome after cold-knife conization of the uterine cervix
2006, Gynecologic Oncology
To estimate the risk for preterm delivery and obstetric complications in women with prior cold-knife conization.
In a retrospective study, we compared 76 deliveries of 65 women with prior cold-knife conization with the remaining 29,711 singleton deliveries at our institution between 1992 and 2002.
We found significant shorter duration of pregnancies in the conization group. Delivery prior to 37 weeks was found in 22.4% (n = 17) of the conization group and in 6.6% (n = 1961) of the controls (OR = 4.07 [2.22–7.10], P < 0.001). Preterm premature rupture of the membranes was found in 17.1% (n = 13) of the conization group and in 2.6% (n = 775) of the controls (OR = 7.70 [3.87–14.21], P < 0.001). Birth weight less than 2500 g was found in 18.4% (n = 14) of the conization group and in 7.7% (n = 2280) of the controls (OR = 2.72 [1.40–4.92], P = 0.002). Overall, birth weight in the conization group was not significantly lower (median 3147 g vs. 3287 g, P = 0.115). Cervical tears were found more frequently in the conization group (8.8% [n = 6] vs. 1.3% [n = 236], OR = 7.53 [2.63–17.57], P < 0.001). There was no difference in mode of delivery, duration of labor, head circumference, chorioamnionitis and use of oxytocin.
Cold-knife conization is a risk factor for preterm birth and preterm premature rupture of the membranes and seems to be a risk factor for cervical tears.
Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: Systematic review and meta-analysis
2006, Lancet
Citation Excerpt :
We identified 27 studies that fulfilled the inclusion criteria,25–51 all of which studied retrospective cohorts. Ten studies reported the effects of LLETZ,25–34 seven of laser conisation,30,35–40 four of laser ablation,30,40,41 and ten of cold knife conisation.42–51 Table 1 summarises the characteristics of these studies, stratified according to the method used and by chronological order.
Conservative methods to treat cervical intraepithelial neoplasia and microinvasive cervical cancer are commonly used in young women because of the advent of effective screening programmes. In a meta-analysis, we investigated the effect of these procedures on subsequent fertility and pregnancy outcomes.
We searched for studies in MEDLINE and EMBASE and classified them by the conservative method used and the outcome measure studied regarding both fertility and pregnancy. Pooled relative risks and 95% CIs were calculated with a random-effects model and interstudy heterogeneity was assessed with Cochrane's Q test.
We identified 27 studies. Cold knife conisation was significantly associated with preterm delivery (<37 weeks; relative risk 2·59, 95% CI 1·80–3·72, 100/704 [14%] vs 1494/27 674 [5%]), low birthweight (<2500 g; 2·53, 1·19–5·36, 32/261 [12%] vs 905/13 229 [7%]), and caesarean section (3·17, 1·07–9·40, 31/350 [9%] vs 22/670 [3%]). Large loop excision of the transformation zone (LLETZ) was also significantly associated with preterm delivery (1·70, 1·24–2·35, 156/1402 [11%] vs 120/1739 [7%]), low birthweight (1·82, 1·09–3·06, 77/996 [8%] vs 49/1192 [4%]), and premature rupture of the membranes (2·69, 1·62–4·46, 48/905 [5%] vs 22/1038 [2%]). Similar but marginally non-significant adverse effects were recorded for laser conisation (preterm delivery 1·71, 0·93–3·14). We did not detect significantly increased risks for obstetric outcomes after laser ablation. Although severe outcomes such as admission to a neonatal intensive care unit or perinatal mortality showed adverse trends, these changes were not significant.
All the excisional procedures to treat cervical intraepithelial neoplasia present similar pregnancy-related morbidity without apparent neonatal morbidity. Caution in the treatment of young women with mild cervical abnormalities should be recommended. Clinicians now have the evidence base to counsel women appropriately.
Iatrogenic consequences of cervical treatment techniques
2005, EMC - Gynecologie-Obstetrique
La conisation est le traitement de référence des lésions de haut grade du col utérin essentiellement dues à Papillomavirus. L'infertilité peut être liée aux modifications des propriétés de l'épithélium glandulaire et comme corollaire de la glaire mais aussi à la sténose cervicale postopératoire. Le respect d'une hauteur minimale de conisation permet d'éviter cette complication.
Conization is the gold standard in the treatment of intra epithelial dysplasias induced by a Papillomavirus. Following cervical treatment, infertility can be due to post-surgical stenosis or inappropriate mucus. The risk of cervical stenosis after conization decreases with the height of the cone (below 20 mm) and the electrosurgical excision procedure.
Triage of the abnormal papanicolau smear in pregnancy
1998, Primary Care - Clinics in Office Practice
Cancer is a dreaded word but is made even more ominous when it occurs during pregnancy. Cervical and breast cancer are the two most common malignancies encountered during pregnancy. For the pregnant woman facing a diagnosis of cancer or trying to decide what the likelihood of conception is after cancer therapy, cancer represents a significant barrier to physical and emotional health. Although cervical cancer tends to be discovered in the early stages of pregnancy, breast cancer tends to be more advanced. Pregnancy does not appear to alter the progression or prognosis of either disease significantly;⁶⁹ however, it is important to make the diagnosis as early as possible so that appropriate clinical decisions can be made by both the patient and her physician.
The pregnant patient facing a diagnosis of preinvasive disease or invasive cervical cancer has many fears and questions and needs to explore the options for management. The patient wonders what the chances are of successfully carrying the fetus to term, what the fetal risks are if treatment is initiated during the prenatal period, and what is the likelihood that delaying therapy until term will adversely affect her or her fetus.⁸⁴ The pregnant patient with cancer may seriously consider termination of the pregnancy. A woman who has had cancer in the past and is now contemplating pregnancy wants to understand the likelihood of successful conception, especially following radiation therapy. The probability of whether or not an additional pregnancy will adversely affect her health is also a serious concern.
In counseling pregnant patients with cervical intraepithelial neoplasia (CIN) or invasive carcinoma, many factors must be considered:
- 1
  The patient's desire for continuation or termination of the pregnancy.
- 2
  The stage of the disease.
- 3
  The number of weeks remaining to achieve fetal viability or lung maturity.
- 4
  The effect of the treatment on subsequent fertility or ability to maintain a normal pregnancy.
Most patients with preinvasive cervical lesions are able to continue routine obstetrical care and a vaginal delivery can be anticipated. For those patients with invasive disease, a delay in therapy must be balanced against the benefit of improved fetal outcome. Whatever the patient's decision, it needs to be explored with sensitivity and knowledge of the current scientific evidence. Unfortunately in many situations, the literature is conflicting and the studies primarily are retrospective.
Impact of therapy for cervical intraepithelial neoplasia on fertility
1996, American Journal of Obstetrics and Gynecology
Cervical intraepithelial neoplasia is endemic in young American women. Because the majority of these women have a strong desire to maintain fertility, the efficacy of treatment modalities for this condition must be weighed against potential negative effects on fertility. Except for cone biopsy, however, the peer-reviewed literature provides little information about the effects of such techniques on fertility. While there are no data demonstrating that the other commonly used therapies (loop electrical excision procedure, cryotherapy, laser vaporization, and diathermy cautery) have a negative impact on fertility, neither has it been definitively proved that they do not have an untoward impact on fertility. Thus further studies are needed, and patients should be educated regarding the limitations of available information when informed consent for treatment is obtained. (Am J Obstet Gynecol 1996;175:1129-36.)

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^∗: Current address: Department of Obstetrics and Gynecology, Division of Oncology, Vanderbilt Medical School, Nashville, Tennessee 37202.

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ObstretricPregnancy following cervical conization

Abstract

Am. J. Obstet. Gynecol

Am. J. Obstet. Gynecol

Am. J. Obstet. Gynecol

Gynecol. Oncol

Long-term follow-up of 1121 cases of carcinoma-in-situ

Obstet. Gynecol

Conization as treatment of carcinoma-insitu of the uterine cervix

Obstet. Gynecol

Conization of the cervix

Surg. Gynecol. Obstet

Graviditaten nach Ringbiopsien Konisationen and Portio-amputationen

Geburtshilfe Frauenheilkd

Obstretric
Pregnancy following cervical conization