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Adverse pregnancy outcomes after treatment for cervical intraepithelial neoplasia

BMJ 2008; 337 doi: (Published 18 September 2008) Cite this as: BMJ 2008;337:a1350
  1. Maija Jakobsson, senior consultant 1,
  2. Fiona Bruinsma, research fellow2
  1. 1Department of Obstetrics and Gynaecology, Helsinki University Hospital, FIN-00029, Helsinki, Finland
  2. 2Mother and Child Health Research, La Trobe University, Melbourne 3000, Australia
  1. maija.jakobsson{at}

    Ablation is safer than excision, but any unnecessary treatment should be avoided

    Cervical cancer caused by infection with human papillomavirus remains a leading cause of death from cancer in women worldwide.1 Premalignant lesions detected by screening are often treated by excision or ablation. Excisional techniques include cold knife conisation, laser conisation, and large loop excision of the transformation zone. Commonly used ablative techniques include laser ablation and cryotherapy, which destroy superficial tissue. All of these techniques are effective. Many women of childbearing age undergo these treatments, so their effect on subsequent pregnancies is important. Two linked studies assess the outcomes of pregnancy after treatment for premalignant lesions of the cervix (cervical intraepithelial neoplasia).2 3

    In a registry cohort study from Norway (doi: 10.1136/bmj.a1343), Albrechtsen and colleagues found that women who had undergone cervical conisation had a significantly higher risk of preterm delivery in subsequent pregnancies than those who had the treatment after delivery and those who were never treated. …

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