Implicaciones obstétricas de los tratamientos escisionales de cérvix por lesiones premalignas

Abstract

ObjectiveThe aim of our study was to analyse the obstetric outcomes in women with a history of excisional treatment for cervical intraepithelial neoplasia and whether there were differences according to the methods of treatment used (loop electrosurgical excision procedure [LEEP] vs. large loop excision of the transformation zone [LLETZ]). Material and methodsA retrospective cohort study was conducted on patients who underwent conization between 2007 and 2014. Outcome measures included maternal age, parity, smoking, childbirth, abortion, interval between conization and delivery, mode of delivery, preterm prelabour rupture of the membranes (PPROM), gestational age and birth weight. A group of 100 patients who had been pregnant during the same period was used as a control group. Results53 (7.9%) patients became pregnant after conization, resulting in 4 (7.5%) miscarriages and 49 (92.5%) deliveries. Increased rate of preterm deliveries (18 vs. 8%, p=.048) and PPROM (22.4 vs. 3%, p=.001) was observed in the conization group. According to technique used, there were more cases of prematurity in the LEEP group against LLETZ (25 vs. 10.5%), RR=1.7 (95% CI: 1.1–2.9), no differences were found in PPROM and low weight. On the other hand, a higher proportion of caesareans was also observed in the conization group versus the control group (38.8 vs. 20%) (57%: LEEP vs. 5.3%: LLETZ, p=.013). DiscussionConservative management and appropriate selection of candidates for conization are important in women with premalignant cervical lesions who wish to become pregnant. Worse results were observed in LEEP group (preterm delivery and PPROM) compared to women who underwent LLETZ.