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Cited by 694Cervical Cancer and HPV ResearchPreterm Birth and ChorioamnionitisEndometrial and Cervical Cancer Treatments

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

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Arbyn, M, Kyrgiou, M, Simoens, C, Raifu, A O, Koliopoulos, G, Martin-Hirsch, P, Prendiville, W, Paraskevaidis, E·2008·BMJ
DOI 10.1136/bmj.a1284PMC PMC2544379
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Abstract

OBJECTIVE: To assess the relative risk of perinatal mortality, severe preterm delivery, and low birth weight associated with previous treatment for precursors of cervical cancer. DATA SOURCES: Medline and Embase citation tracking from January 1960 to December 2007. Selection criteria Eligible studies had data on severe pregnancy outcomes for women with and without previous treatment for cervical intraepithelial neoplasia. Considered outcomes were perinatal mortality, severe preterm delivery (<32/34 weeks), extreme preterm delivery (<28/30 weeks), and low birth weight (<2000 g, <1500 g, and <1000 g). Excisional and ablative treatment procedures were distinguished. RESULTS: One prospective cohort and 19 retrospective studies were retrieved. Cold knife conisation was associated with a significantly increased risk of perinatal mortality (relative risk 2.87, 95% confidence interval 1.42 to 5.81) and a significantly higher risk of severe preterm delivery (2.78, 1.72 to 4.51), extreme preterm delivery (5.33, 1.63 to 17.40), and low birth weight of <2000 g (2.86, 1.37 to 5.97). Laser conisation, described in only one study, was also followed by a significantly increased chance of low birth weight of <2000 g and <1500 g. Large loop excision of the transformation zone and ablative treatment with cryotherapy or laser were not associated with a significantly increased risk of serious adverse pregnancy outcomes. Ablation by radical diathermy was associated with a significantly higher frequency of perinatal mortality, severe and extreme preterm delivery, and low birth weight below 2000 g or 1500 g. CONCLUSIONS: In the treatment of cervical intraepithelial neoplasia, cold knife conisation and probably both laser conisation and radical diathermy are associated with an increased risk of subsequent perinatal mortality and other serious pregnancy outcomes, unlike laser ablation and cryotherapy. Large loop excision of the transformation zone cannot be considered as completely free of adverse outcomes.

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  • The risk of prematurity in subsequent pregnancies increases with increasing treatment radicality and length of cone excised.

    “The risk of prematurity in subsequent pregnancies has been known to increase with increasing treatment radicality and length of cone excised.”

    From Comparative effectiveness and risk of preterm birth of local treatments for cervical intraepithelial neoplasia and stage IA1 cervical cancer: a systematic review and network meta-analysis (2022) · cites this paper as [9]

    The Discussion (Biological mechanisms; page unavailable) reports a positive association between depth of excision and adverse obstetric events, but presents the link between the amount of tissue removed and obstetric morbidity as a hypothesis. The Results (Severe and extreme preterm delivery; page unavailable) show higher risks after some procedures, but do not establish a consistent increase in prematurity with each increase in treatment radicality or cone length. (LLM, conf=0.82)

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Authors
Arbyn, M., Kyrgiou, M., Simoens, C., Raifu, A. O., Koliopoulos, G., Martin-Hirsch, P., Prendiville, W., & Paraskevaidis, E.
Affiliations
  • Institut Scientifique de Santé Publique (BE)
  • Lancashire Teaching Hospitals NHS Foundation Trust (GB)
  • University Hospital of Ioannina (GR)
  • Coombe Women & Infants University Hospital (IE)
Corresponding author
Arbyn, M
ORCID
Venue
BMJ
Publisher
BMJ
Published
2008-09-18
Volume
337
Issue
sep18 1
Pages
a1284-a1284
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.a1284
PMC
PMC2544379
OpenAlex
W2073934456
Cited by
694
References
5
Citations by year
2026: 14 · 2025: 14 · 2024: 17 · 2023: 27 · 2022: 37 · 2021: 25 · 2020: 21 · 2019: 32 · 2018: 35 · 2017: 35 · 2016: 53 · 2015: 52 · 2014: 54 · 2013: 63 · 2012: 56
FWCI
5.64
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMJ (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • European Commission
  • La Trobe University
  • Fonds De La Recherche Scientifique - FNRS
  • Services Fédéraux des Affaires Scientifiques, Techniques et Culturelles
  • Vlaamse regering
Topics
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
  • Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
  • Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
Keywords
cervical intraepithelial neoplasia, perinatal mortality, preterm birth, low birth weight, adverse pregnancy outcomes, cryotherapy, LLETZ, cervical cancer treatment
MeSH terms
Uterine Cervical Dysplasia, Uterine Cervical Neoplasms, Female, Humans, Infant, Low Birth Weight, Infant, Newborn, Obstetric Labor, Premature, Pregnancy, Pregnancy Complications, Neoplastic, Pregnancy Outcome, Risk Factors, Obstetric Surgical Procedures, Perinatal Mortality

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