Influence of destructive methods of the cervix on reproductive function of woman

Abstract

After destructive methods of treatment of the cervix, women are at high risk for the development of gestational complications as one of the causes of reproductive losses, which determines the social significance of the problem.The objective: to carry out a comparative analysis of the reproductive function in women who have undergone various surgical interventions on the cervix, to study the effect of destructive methods of treating cervical pathology on the course of pregnancy to improve the principles of antenatal care.Materials and methods. All examined women (n=201) who underwent organ-sparing operations (electroconization, cryodestruction, laser vaporization or radiowave excision) on the cervix for dysplasia of I-III degree, were divided into 3 groups: 1 group (retrospective, n=114) – patients in whom the features of menstrual and reproductive function were studied anamnestically; group 2 (prospective, n=57) – women who were included in the study immediately after surgery; group 3 (control, n=30) – almost healthy women. Patients in the comparative groups were comparable in age (mean age 25,7±4,4 years) and the course of the pathological process in the cervix.Results. In a 5-year study, menstrual and generative functions in patients after surgery were studied. Menstrual function is preserved in all patients, but most women complain of algodysmenorrhea and bleeding before and after menstruation: the highest percentage – in women after electroconization, the lowest – after cryodestruction, after laser vaporization and radiowave excision changes were not observed.In the analysis of pregnancy complications, the most significant were significant differences between the percentage of pregnant women at risk of abortion in the first two groups (47,9% and 26,0%, respectively) and the control group (14,8%), which can be explained by the development of isthmic-cervical insufficiency. Patients who underwent surgery on the cervix, as well as the presence of placental dysfunction, confirmed by violations of doppler indices.Conclusion. Modern destructive methods of treatment of cervical pathology, the least traumatic of which are laser vaporization and radiowave excision, can cure the underlying disease and preserve both menstrual and generative functions. Taking into account the clinical picture of the disease and the established diagnosis, it is necessary to develop individual management tactics for each patient, to conduct active monitoring during the year after surgery and observation during the year after pregnancy, regardless of its outcome.