Cone Biopsies of Cervix Tied to Adverse Pregnancy Outcomes
Last Updated: 2010-02-01 12:35:43 -0400 (Reuters Health)
Conization is generally used for cervical intraepithelial neoplasia (CIN).
Dr. Willy Poppe, an author on one of the papers, told Reuters Health by email, "Conization remains a risk factor for earlier delivery and smaller newborns. Whether this is caused by the procedure or cervical disease and its related risk factors remains unknown."
Dr. Poppe and colleagues at University Hospitals Leuven, Belgium, retrospectively compared 55 pregnancies in 34 women after conization, and 55 pregnancies in 54 women without CIN or a history of conization.
Gestational age at delivery, neonatal head circumference and birth weight were significantly lower in the conization group.
Moreover, 25% of the study group delivered before 37 weeks of gestation compared to only 4% of controls, and 11% of the conization group delivered before 34 weeks. There were no severely preterm deliveries in the control group. There were no perinatal deaths in either group.
Given these findings, Dr. Poppe said, "Women should not undergo a conization without clear indication, and the size of the cone must be tailored and kept minimal according to the size of the lesion."
Dr. Gitte Ortoft from
"All young women that need a conization are informed of the risk of preterm delivery before the operation," she said. "When we do conizations we try to make the conus as small as possible."
Dr. Ortoft and her colleagues reported on 721 deliveries in women who each had a single conization and 37 deliveries in women who each had two. This research team also looked at 390 deliveries in women with a history of dysplasia not treated with conization, as well as more than 74,000 deliveries in women with neither dysplasia nor conization.
The frequency of preterm delivery was 11.1% after conization, 3.9% in women with dysplasia, and 4.1% in women without dysplasia. Women with two conizations had a preterm delivery rate of 33%.
A single conization increased the adjusted hazard ratio for delivery before 37 weeks to 2.8 and for delivery before 28 weeks to 4.9, compared to no conization. Hazard ratios for these endpoints after two conizations were 9.9 and 9.8, respectively.
The researchers also found an almost three-fold increase in the risk of perinatal mortality after one conization, mainly, they say, "because of the death of babies born prior to 28 weeks of gestation."
In her comments to Reuters Health, Dr. Ortoft said, "We find that it is a difficult situation wanting to prevent cervical cancer in our women and at the same time introducing an increased risk of serious perinatal outcome."
She and her associations seldom use the approach in women with moderate dysplasia "if they still have a wish for further pregnancies," she added.
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BJOG 2010;117:258-267,268-273.
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