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Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis

The Lancet (British edition), 2006-02, Vol.367 (9509), p.489-498 [Peer Reviewed Journal]

2006 Elsevier Ltd ;2006 INIST-CNRS ;Copyright Lancet Ltd. Feb 11-Feb 17, 2006 ;ISSN: 0140-6736 ;EISSN: 1474-547X ;DOI: 10.1016/S0140-6736(06)68181-6 ;PMID: 16473126 ;CODEN: LANCAO

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  • Title:
    Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis
  • Author: Kyrgiou, M ; Koliopoulos, G ; Martin-Hirsch, P ; Arbyn, M ; Prendiville, W ; Paraskevaidis, E
  • Subjects: Adult ; Biological and medical sciences ; Birth Weight ; Cervical cancer ; Cervical Intraepithelial Neoplasia - therapy ; Clinical outcomes ; Conization ; Delivery, Obstetric - statistics & numerical data ; Female ; Fertility ; General aspects ; Humans ; Infant, Newborn ; Laser Therapy ; Medical sciences ; Meta-analysis ; Obstetrics ; Pregnancy ; Pregnancy Complications, Neoplastic - surgery ; Pregnancy Outcome ; Studies ; Systematic review ; Uterine Cervical Neoplasms - surgery
  • Is Part Of: The Lancet (British edition), 2006-02, Vol.367 (9509), p.489-498
  • Description: 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.
  • Publisher: London: Elsevier Ltd
  • Language: English
  • Identifier: ISSN: 0140-6736
    EISSN: 1474-547X
    DOI: 10.1016/S0140-6736(06)68181-6
    PMID: 16473126
    CODEN: LANCAO
  • Source: ProQuest One Psychology
    MEDLINE
    ProQuest Central
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