Is the increased risk of preterm birth following excision for cervical intraepithelial neoplasia restricted to the first birth post treatment?

被引：28

作者：

Castanon, A. ^{[1
]}

Landy, R. ^{[1
]}

Brocklehurst, P. ^{[2
]}

Evans, H. ^{[3
]}

Peebles, D. ^{[2
]}

Singh, N. ^{[4
]}

Walker, P. ^{[3
]}

Patnick, J. ^{[5
]}

Sasieni, P. ^{[1
]}

机构：

[1] Queen Mary Univ London, Wolfson Inst Prevent Med, Barts & London Sch Med, Ctr Canc Prevent, London, England

[2] Inst Womens Hlth UCL, London, England

[3] Royal Free Hampstead NHS Trust, Dept Gynaecol, London, England

[4] Barts Hlth, Div Cellular Pathol, London, England

[5] Publ Hlth England, NHS Canc Screening Programmes, Sheffield, S Yorkshire, England

来源：

BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY | 2015年 / 122卷 / 09期

基金：

美国国家卫生研究院;

关键词：

Cervical intraepithelial neoplasia; conisation; large loop excision of the transformation zone; preterm delivery; SCHOOL-AGE; OUTCOMES; DELIVERY; DEPTH; BORN; TERM;

D O I：

10.1111/1471-0528.13398

中图分类号：

R71 [妇产科学];

学科分类号：

100211 ;

摘要：

ObjectiveTo explore whether the increased risk of preterm birth following treatment for cervical disease is limited to the first birth following colposcopy. DesignNested case-control study. SettingTwelve NHS hospitals in England. PopulationAll nonmultiple births from women selected as cases or controls from a cohort of women with both colposcopy and a hospital birth. Cases had a preterm (20-36weeks of gestation) birth. Controls had a term birth (38-42weeks) and no preterm. MethodsObstetric, colposcopy and pathology details were obtained. Main outcome measuresAdjusted odds ratio of preterm birth in first and second or subsequent births following treatment for cervical disease. ResultsA total of 2798 births (1021 preterm) from 2001 women were included in the analysis. The risk of preterm birth increased with increasing depth of treatment among first births post treatment [trend per category increase in depth, categories <10mm, 10-14mm, 15-19mm, 20mm: odds ratio (OR) 1.23, 95% confidence interval (95% CI) 1.12-1.36, P<0.001] and among second and subsequent births post treatment (trend OR 1.34, 95% CI 1.15-1.56, P<0.001). No trend was observed among births before colposcopy (OR 0.98, 95% CI 0.83-1.16, P=0.855). The absolute risk of a preterm birth following deep treatments (15mm) was 6.5% among births before colposcopy, 18.9% among first births and 17.2% among second and subsequent births post treatment. Risk of preterm birth (once depth was accounted for) did not differ when comparing first births post colposcopy with second and subsequent births post colposcopy (adjusted OR 1.15, 95% CI 0.89-1.49). ConclusionsThe increased risk of preterm birth following treatment for cervical disease is not restricted to the first birth post colposcopy; it remains for second and subsequent births. These results suggest that once a woman has a deep treatment she remains at higher risk of a preterm birth throughout her reproductive life. Tweetable abstractRisk of preterm birth following large treatments for cervical disease remains for second and subsequent births.

引用

页码：1191 / 1199

页数：9

共 26 条

[1] 2011 Colposcopic Terminology of the International Federation for Cervical Pathology and Colposcopy [J].