Elsevier

Obstetrics & Gynecology

Volume 90, Issue 6, December 1997, Pages 978-982
Obstetrics & Gynecology

Original Articles
Duration of Pregnancy After Carbon Dioxide Laser Conization of the Cervix: Influence of Cone Height

https://doi.org/10.1016/S0029-7844(97)00489-4Get rights and content

Abstract

Objective: To determine if carbon dioxide laser conization of the cervix is a risk factor for preterm delivery in subsequent gestations and to evaluate whether there is any relationship between cone height and duration of pregnancy.

Methods: Patients of fertile age who had carbon dioxide laser conization were followed for reproductive events. Cases were matched one-to-one with controls for known risk factors for preterm delivery. Pregnancy duration, rate of preterm birth, and mode of delivery were studied. Parametric and nonparametric tests were used for statistical analysis. Logistic regression analysis and Cox proportional hazard modeling were used to investigate the relationship between cone height and subsequent preterm delivery.

Results: Sixty-four women with singleton pregnancies after carbon dioxide laser conization and 64 controls were included in the study. Overall, no difference was found in the rate of preterm delivery and duration of pregnancy. However, women with cone height of at least 10 mm had a higher rate of preterm delivery than either those with cone height less than 10 mm (five of 23 versus one of 41, P = .01) or the controls (five of 23 versus three of 64, P < .05). Cone height of at least 10 mm remained significant in predicting the occurrence of preterm delivery and the duration of pregnancy after adjusting for known risk factors (odds ratio 11.1, P < .05).

Conclusion: Cone height of at least 10 mm is an independent risk factor for the duration of pregnancy and for the occurrence of preterm delivery in the subsequent gestation.

Section snippets

Materials and Methods

This study was conducted at the Department of Obstetrics and Gynecology of Münsterlingen, Kantonsspital, Switzerland, from August 1, 1986, to December 31, 1994. Laser conization using the technique proposed by Dorsey and Diggs[9]was performed in 228 women younger than 35 years of age with cervical intraepithelial neoplasia (CIN). Patients were observed for reproductive events. Twenty-six patients were lost to follow-up. By December 31, 1996, 117 pregnancies occurred in 78 patients who had

Results

Sixty-four women who had singleton pregnancies after carbon dioxide laser conization of the cervix were included in the study. The indications for cervical conization were CIN grade 3 in 33 cases, grade 2 in 22 cases, and grade 1 in nine cases. The clinical characteristics of the study population are summarized in Table 1. There were no differences between cases and controls in the incidence of preterm delivery (six of 64 [9.4%] versus three of 64 [4.7%], respectively), preterm premature

Discussion

A MEDLINE search of the literature from January 1978 through January 1997 was performed to identify studies of pregnancy after carbon dioxide laser conization of the cervix. Search terms used, alone or in combination, were conization, cervix, pregnancy outcome, and preterm delivery. Our search indicates that this is the largest study of patients with singleton gestation after carbon dioxide laser conization of the uterine cervix, and it is the first report that demonstrates an association

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