History Of Conization Research Articles

The Role of Preoperative Inflammatory Markers in Cervical Cerclage Success.

To compare the inflammatory markers between therapeutic and emergency cerclage and assess the predictive role of inflammatory markers for the latency period. Descriptive study. Place and Duration of the Study: Department of Obstetrics and Gynaecology, Bursa Yuksek Ihtisas Training and Research Hospital, Turkiye, from January 2016 to September 2022. The therapeutic cerclage group (n = 64) included patients with a history of cervical insufficiency, normal prenatal screening test results, and who underwent cerclage based on history indications. The emergency cerclage group (n = 14) included patients with painless cervical dilation in the second trimester or a history of preterm and a short cervix on ultrasonography. Exclusion criteria composed of multiple pregnancies, active uterine contractions, vaginal bleeding, chorioamnionitis, membrane rupture, foetal anomalies, history of conization or abdominal cerclage, and having inflammatory diseases. Sociodemographic features, perinatal outcomes, and inflammatory markers such as neutrophil-to-lymphocyte ratio, C-reactive protein, and systemic immune-inflammation index were compared. Systemic immune-inflammation index was calculated by formulating the multiplication value of the neutrophil and platelet count divided by the lymphocyte count. The latency period was shorter (5.5 (0-29) vs. 20 (1-31) weeks, p <0.001) in the emergency cerclage group. Neutrophil-to- lymphocyte ratio and systemic immune-inflammation index, which are representatives of increased inflammatory state, were significantly higher in the emergency cerclage group (p = 0.007 for both). Systemic immune-inflammation index was correlated with cerclage to delivery interval for all patients (r = -0.307, p = 0.006). Also, it predicted neonatal mortality with a cut-off value of 1078.08, 90% sensitivity and 70.59% specificity (AUC = 0.776, p <0.001) and low Apgar scores with 57.1% sensitivity and 74% specificity (AUC = 0.641, p = 0.038). Systemic immune-inflammation index, correlated with cerclage to delivery interval, could be a marker for predicting neonatal mortality and morbidity in cerclage patients. Cervical cerclage, Inflammatory markers, Perinatal outcomes, Systemic immune-inflammation index.

Uterine cervical conisation and chorioamnionitis: A nationwide observational study.

To investigate whether conisation increases chorioamnionitis (CAM) and assess whether this risk differs between preterm and term periods. Furthermore, we estimated mediation effects of CAM between conisation and preterm birth (PTB). A nationwide observational study. Japan. Singleton pregnant women derived from the perinatal registry database of the Japan Society of Obstetrics and Gynaecology between 2013 and 2019. The association between a history of conisation and clinical CAM was examined using a multivariable logistic regression model with multiple imputation. We conducted mediation analysis to estimate effects of CAM on PTB following conisation. Clinical CAM. Of 1 500 206 singleton pregnant women, 6961 (0.46%) underwent conisation and 1 493 245 (99.5%) did not. Clinical CAM occurred in 150 (2.2%) and 11 484 (0.8%) women with and without conisation, respectively. Conisation was associated with clinical CAM (odds ratio [OR] 3.09; 95% confidence interval (CI) 2.63-3.64; p < 0.001) (risk difference 1.57%; 95% CI 1.20-1.94). The association was detected among 171 440 women with PTB (OR 3.09; 95% CI 2.57-3.71), whereas it was not significant among 1 328 284 with term birth (OR 0.88; 95% CI 0.58-1.34). OR of total effect of conisation on PTB was 2.71, OR of natural indirect effect (effect explained by clinical CAM) was 1.04, and OR of natural direct effect (effect unexplained by clinical CAM) was 2.61. The proportion mediated was 5.9%. Conisation increased CAM occurrence. Obstetricians should be careful regarding CAM in women with conisation, especially in preterm period. Bacterial infections may be an important cause of PTB after conisation.

Vaginal Microbiota and Pregnancy Outcomes of Patients with Conization Histories.

Background: One of the major risks of preterm birth is a history of conization. However, the risk of infection due to this procedure is still not well known. Using next-generation sequencing, we aimed to reveal the influence of conization on vaginal microbiota in the following pregnancy, and their relationship between spontaneous preterm birth (sPTB). Methods: We conducted a prospective cohort study including 133 pregnant patients, of whom 25 had conization histories and 108 did not. Vaginal microbiome samples were collected using swabs by an obstetrician upon inclusion in the first trimester and during delivery. V1-V2 of the 16S rRNA gene were amplified and analyzed to identify the bacteria. Results: The conization group had a significantly lower delivery week (34 weeks vs. 36 weeks, p = 0.003) and higher sPTB rate (64% vs. 8.3%, p ≤ 0.001) than the control group. In the conization group, alpha (Chao 1, p = 0.02; phylogenetic diversity whole tree, p = 0.04) and beta diversity (permutational multivariate analysis of variance test, p = 0.04) of the vaginal microbiota was significantly higher during delivery in patients who delivered preterm than in those who delivered term. Community-state type IV in the first trimester was significantly associated with sPTB (overall odds ratio 3.80, 95% confidence interval 1.33-10.8, p = 0.01). Conclusions: Conization is a risk factor for sPTB. Increased risk of sPTB in patients after conization may belong to the vulnerable defense mechanism, due to the shortened cervix and decreased cervical mucus.

Obstetric outcomes after cervical loop electrosurgical excision procedure

ObjectivesThis study aimed to investigate whether a history of loop electrosurgical excision procedure (i.e., conisation) affects obstetric and neonatal outcomes. MethodsA retrospective cohort study was carried out in Västernorrland county, Sweden. 57 nulliparous women with singleton pregnancies and previous conisation were compared with 100 age-matched pregnant controls without history of conisation. ResultsThere was significantly lower gestational age by delivery (p = 0.036), however, the premature delivery rate was not different. Caesarean section was also less frequent (OR: 0.29, 95% CI: 0.081–1.04, p = 0.047) in the conisation group than those in the control group. There were no differences in neonatal outcomes. ConclusionsPrevious conisation does not affect the risk of prematurity or cervical dilatation during the first stage of labour. Women with history of conisation had a lower rate of caesarean section, and lower gestational age by delivery.

Prophylactic Cerclage to Prevent Preterm Birth after Conization: A Cohort Study Using Data from the National Health Insurance Service of Korea.

PurposeTo investigate potential differences in the frequency of preterm births (PTB) between pregnancies with or without prophylactic cerclage in women with a history of conization.Materials and MethodsWe identified women who had their first singleton delivery after conization between 2013 and 2018 using records in the National Health Insurance Service of Korea claims database. We only included women who had undergone a health examination and interview within 2 years before delivery. We used timing of maternal serum alpha-fetoprotein (MSAFP) tests to differentiate early (before) from late (after the MSAFP test) cerclage. The frequency of adverse pregnancy outcomes, including PTB, preterm labor and premature rupture of membranes, antibiotics and tocolytics use, cesarean delivery, and number of admissions before delivery, were compared.ResultsA total of 8322 women was included. Compared to the no cerclage group (n=7147), the risks of adverse pregnancy outcomes were higher in the cerclage group (n=1175). After categorizing patients with cerclage into two groups, the risk of PTB was still higher in the early cerclage group than in the no cerclage group after adjusting for baseline factors (4.48%, 30/669 vs. 2.77%, 159/5749, odds ratio 2.42, 95% confidence interval 1.49, 3.92). Other adverse pregnancy outcomes were also more frequent in the early cerclage group than the no cerclage group.ConclusionEarly cerclage performed before MSAFP testing does not prevent PTB in pregnancy with a history of conization, but increases the risk of adverse pregnancy outcomes, including PTB.

Interventions to Try to Prevent Preterm Birth in Women With a History of Conization: A Systematic Review and Meta-analyses.

The most effective preterm birth (PTB) intervention is unknown for women who are at risk of PTB due to a history of conization. The objective of this systematic review was to determine whether PTB interventions, progesterone, cerclage, and pessary decrease the risk of PTB compared to no treatment in singleton-and separately in twin-pregnancies of women with history of conization. We searched Cochrane Central, MEDLINE, EMBASE, CINAHL, and ClinicalTrials.gov from January 1994 until May 2017. In duplicate, we reviewed titles, abstracts, full texts, extracted data, and assessed quality. We included RCTs and observational studies. Our primary outcomes were PTB <34 weeks, PTB <37 weeks, and neonatal mortality. We performed random effects meta-analyses and generated ORs with 95% CIs. We screened 762 nonduplicate titles and abstracts and assessed 91 full texts. After contacting authors, we included nine studies. Women in the cerclage group were more likely to have a short cervix or another risk factor for PTB, raising the possibility of confounding by indication. In women with a history of conization and a singleton who received a cerclage compared to those who did not, the ORs of PTB <34 weeks was 3.99 (95% CI 0.67-23.62, three studies, I2 = 65%); of PTB <37 weeks was 2.10 (95% CI 0.87-5.05, four studies, I2 = 0%); and of neonatal mortality was 8.33 (95% CI 0.22-320.38, two studies, I2 = N/A). We did not find any studies comparing either progesterone or pessary to no treatment. Data for twins were very scarce. In women with a previous conization and a current singleton gestation, the existing evidence, which is likely limited due to confounding by indication, does not support cerclage or other interventions used to try to decrease PTB.

Cold-knife conisation and large loop excision of transformation zone significantly increase the risk for spontaneous preterm birth: a population-based cohort study

ObjectivesOur aim was to explore the association between cold-knife conisation and large loop excision of transformation zone (LLETZ) with spontaneous preterm birth in a large 10-year national sample. We wanted to explore further the association of these procedures with preterm birth according to gestation. Study designWe conducted a population based retrospective cohort study, using data from national Medical Birth Registry. The study population consisted of all women giving birth to singletons in the period 2003–2012 in Slovenia, excluding all induced labors and elective cesarean sections before 37 weeks of gestation (N=192730). We compared the prevalence of spontaneous preterm births (before 28 weeks, before 32 weeks, before 34 weeks and before 37 weeks of gestation) in women with cold-knife conisation or LLETZ compared to women without history of conisation, calculating odds ratios (OR), adjusted for potential confounders. Chi-square test was used for descriptive analysis. Logistic regression analyses were performed to estimate crude odds ratio (OR) and adjusted odds ratio (aOR) and their 95% confidence intervals (95% CI) with two-sided probability (p) values. ResultsA total of 8420 (4.4%) women had a preterm birth before 37 weeks of gestation, 2250 (1.2%) before 34 weeks of gestation, 1333 (0.7%) before 32 weeks of gestation and 603 (0.3%) before 28 weeks of gestation. A total of 4580 (2.4%) women had some type of conisation in their medical history: 2083 (1.1%) had cold-knife conisation and 2498 (1.3%) had LLETZ. In women with history of cold-knife conisation, the adjusted OR for preterm birth before 37 weeks of gestation was 3.13 (95% CI; 2.74–3.57) and for preterm birth before 28 weeks of gestation 5.96 (95% CI; 4.3–8.3). In women with history of LLETZ, the adjusted OR was 1.95 (95% CI; 1.68–2.25) and 2.88 (95% CI; 1.87–4.43), respectively. ConclusionsWomen with cervical excision procedure of any kind have significantly increased odds for preterm birth, especially for preterm birth before 28 weeks and before 32 weeks of gestation.

Étude cas-témoin des conséquences obstétricales de la conisation

Evaluate the obstetrical outcomes in the case of women with a history of conization. Determine the role of the cone length in the obstetrical issue. Retrospective case-control study including the patients (n=39) who had undergone a conization in a university hospital between January 2002and January 2012. The obstetrical outcomes have been compared to those from a control group (n=78). Into the exposed group the obstetrical outcomes has been compared based on the cone length. Thirty-one patients delivered after a conization (39deliveries). The obstetrical outcomes have been significantly increased in the exposed group: preterm delivery before 37weeks gestation (25.6% vs 7.7%, P=0.01), before 32weeks gestation (15.4% vs 1.3%, P=0.005) and between 28weeks gestation (10.2% vs 0%, P=0.01), premature onset of labor before 32weeks gestation (12.8% vs 1.3%, P=0.01) and before 28weeks gestation (12.8% vs 0%, P=0.01) and preterm premature rupture of membranes before 37weeks gestation (20.5% vs 1.3%, P<0.001). There was no significant difference for a length cone more than 1.5cm. Our study showed that a history of conization is an obstetrical risk factor to consider in the management of a subsequent pregnancy.

Is Early Treatment with a Cervical Pessary an Option in Patients with a History of Surgical Conisation and a Short Cervix?

Objective: Patients with a history of one or more conizations have an increased risk of spontaneous preterm birth (SPTB). The aim of this study was to investigate the outcome of pregnancies in patients with a history of conization and early treatment with a cervical pessary. Methods: In this pilot observational study we included 21 patients and evaluated the obstetric history, the interval between pessary placement and delivery, gestational age at delivery, the neonatal outcome and the number of days of maternal and neonatal admission. Results: Among the study group of 21 patients, 20 patients had a singleton and one had a dichorionic/diamniotic twin pregnancy. At insertion, the mean gestational age was 17 + 2 (10 + 5-24 + 0) weeks and the mean cervical length was 19 (4-36) mm. Six patients presented with funneling at insertion with a mean funneling width of 19.7 (10-38) mm and funneling length of 19.9 (10-37) mm. Five patients had already lost at least one child due to early spontaneous preterm birth and another five had at least one previous abortion, who have now delivered beyond 34 weeks. The mean gestational age at delivery was 38 (31 + 1-41 + 0) gestational weeks and the mean interval between insertion and delivery was 145 (87-182) days. Conclusion: Our findings suggest a beneficial effect of an early pessary placement for patients at high-risk for preterm birth due to conization.

Attendance at Cervical Cancer Screening and Use of Diagnostic and Therapeutic Procedures on the Uterine Cervix Assessed from Individual Health Insurance Data (Belgium, 2002-2006)

ObjectiveTo assess the coverage for cervical cancer screening as well as the use of cervical cytology, colposcopy and other diagnostic and therapeutic interventions on the uterine cervix in Belgium, using individual health insurance data.MethodsThe Intermutualistic Agency compiled a database containing 14 million records from reimbursement claims for Pap smears, colposcopies, cervical biopsies and surgery, performed between 2002 and 2006. Cervical cancer screening coverage was defined as the proportion of women aged 25–64 that had a Pap smear within the last 3 years.ResultsCervical cancer screening coverage was 61% at national level, for the target population of women between 25 and 64 years old, in the period 2004–2006. Differences between the 3 regions were small, but varied more substantially between provinces. Coverage was 70% for 25–34 year old women, 67% for those aged 35–39 years, and decreased to 44% in the age group of 60–64 years. The median screening interval was 13 months. The screening coverage varied substantially by social category: 40% and 64%, in women categorised as beneficiary or not-beneficiary of increased reimbursement from social insurance, respectively. In the 3-year period 2004–2006, 3.2 million screen tests were done in the target group consisting of 2.8 million women. However, only 1.7 million women got one or more smears and 1.1 million women had no smears, corresponding to an average of 1.88 smears per woman in three years of time. Colposcopy was excessively used (number of Pap smears over colposcopies = 3.2). The proportion of women with a history of conisation or hysterectomy, before the age of 65, was 7% and 19%, respectively.ConclusionThe screening coverage increased slightly from 59% in 2000 to 61% in 2006. The screening intensity remained at a high level, and the number of cytological examinations was theoretically sufficient to cover more than the whole target population.

503: Implementation of a universal cervical length surveillance program for prediction of preterm birth

503 Implementation of a universal cervical length surveillance program for prediction of preterm birth Kelly Orzechowski, Sara Nicholas, Stuart Weiner, Jason Baxter, Vincenzo Berghella Thomas Jefferson University Hospital, Obstetrics & Gynecology, Philadelphia, PA OBJECTIVE: To evaluate factors associated with successful implementation of a universal cervical length (CL) screening program for prediction of preterm birth. STUDY DESIGN: We performed a retrospective cohort study to evaluate the acceptability of universal CL screening program for the prediction of preterm birth (PTB) between January 1, 2012 and June 30, 2012. Women with singleton gestations undergoing obstetric ultrasounds between 18 0/7-23 6/7 weeks were eligible for CL screening. Patients with prior spontaneous PTB were excluded. CL measurements were always performed in a uniform fashion with transvaginal ultrasound and the results were interpreted according to a standard protocol (Figure). Sonographers and medical staff received education prior to implementation and appointment times were extended by 10 minutes. Patients received educational handouts at check-in. On June 1, 2012, our program was modified from “opt-in” to “opt-out” in attempt to improve patient acceptance rates. Independent samples Mann-Whitney U, Chi-square, and independent samples t-tests were performed using SPSS 20.0. RESULTS: During the study period, 733 (82%) of 898 eligible patients were offered CL screening. Women were more likely to accept CL screening if they were nulliparous and if the sonographer was female. Implementation of an “opt-out” CL screening program significantly increased the percentage of women screened (Table). Among 561 women who accepted CL screening, 9 (1.6%) had a CL 25mm and 6 (1%) had a CL 20mm and were offered vaginal progesterone. CONCLUSION: Universal CL screening is acceptable to most women and is feasible to implement on a large scale. Patient education is necessary to achieve optimal rates of acceptance. An “Opt-out” screening approach increases acceptance rates. 504 Does cervical conization increase the risk of a sonographic short cervix in the second trimester of pregnancy? Kelly Orzechowski, Sara Nicholas, Vincenzo Berghella Thomas Jefferson University Hospital, Obstetrics & Gynecology, Philadelphia, PA OBJECTIVE: To evaluate whether prior cervical conization increases the incidence of a sonographic short cervix in the second trimester of pregnancy. STUDY DESIGN: We conducted a retrospective cohort study from January 1, 2012 to June 30, 2012 involving women with singleton gestations between 18 0/7-23 6/7 weeks undergoing universal cervical length (CL) screening with transvaginal ultrasound for prediction of preterm birth. Women with a prior spontaneous preterm birth and those receiving prenatal care at outside institutions were excluded. History of cervical conization including cold knife conization (CKC) and Loop Electrosurgical Excision Procedure (LEEP) was determined by review of the prenatal record. The primary outcomes were mean CL measurement and the incidence of a short cervix (CL 20mm) among women with and without prior cervical conization. Independent samples Mann-Whitney U, Chi-square, and independent samples t-tests were performed using SPSS 20.0. RESULTS: During the study period, 527 women underwent second trimester CL screening, and of those, 33 (6.2%) had a documented history of prior conization (4 CKC and 29 LEEP). Demographic characteristics between the groups are shown in the Table. The mean midtrimester cervical length in women with prior cervical conizations was significantly shorter compared to women without a history of conization (39mm vs. 43mm, p 0.012). Women with prior conization also had a significantly higher incidence of CL 25mm (6% vs. 1%, p 0.046) as well as a non-significant higher incidence of CL 20mm. CONCLUSION: In a universal CL screening program, women with prior cervical conizations have shorter second trimester cervical lengths and a higher incidence of short cervix compared to women without such a history. Universal CL screening algorithm Demographics and outcomes of a universal CL screening program

Obstetric and neonatal outcome after surgical treatment of cervical dysplasia

Conization is the gold standard today for the management of severe cervical dysplasia. However, with the increasing delay until first pregnancy, obstetric follow-up of patients with a history of conization is a growing concern. Retrospective case-control study using data from the electronic database of a university hospital. We compared the obstetric and neonatal outcome of 106 pregnancies delivered after conization with the outcome of 212 pregnancies of patients with no history of conization. A significant reduction in the mean gestational age at delivery (38.23 ± 2.51 weeks vs. 39.15 ± 1.56 weeks) was observed, together with a higher rate of premature rupture of the membrane (9.4% vs. 1.9%), premature onset of labor (9.4% vs. 2.4%), premature delivery (17% vs. 3.8%) and neonatal hospitalization (17.9% vs. 6.6%) in the group of patients with history of conization. Children born to women who had surgery had a significantly lower birth weight (3146.9 ± 611 g vs. 3347.3 ± 502 g) and size (49.1 ± 2.6 cm vs. 50.0 cm ± 2.2 cm) than those of the control group. Furthermore, these children were more frequently admitted in the neonatal intensive care unit (22.6% vs. 10.4%, p=0.004). Conization is an important risk factor for premature birth and women with a history of conization require cautious obstetric management during pregnancy. Anti-HPV vaccination and proactive surveillance of low-grade or moderate dysplasia, instead of immediate surgery, should be encouraged in young patients.

Pregnancy outcome after cervical conisation: a retrospective cohort study in the Leuven University Hospital

To assess pregnancy outcome after conisation. Retrospective cohort study. Belgium, data from a university hospital. Fifty-five pregnancies in 34 women after conisation, and 55 pregnancies in 54 women without a history of conisation or cervical intraepithelial neoplasia (CIN). Hospital data were reviewed and questionnaires were collected from 599 women who had a conisation in a 5-year period, among whom subsequent pregnancies were identified. The control group consisted of matched pregnancies of women without a history of conisation. Gestational age at delivery, neonatal biometry, neonatal condition at birth. Numbers of sexual partners (4.6 +/- 3.4 SD versus 2.5 +/- 2.5 SD) and ex-smokers were significantly higher in the study group compared with the control group. Gestational age at delivery (266 +/- 2 days versus 274 +/- 9 days), neonatal head circumference (33.9 +/- 2.5 cm, versus 34.6 +/- 2.5 cm) and birthweight (3088 +/- 754 g versus 3381 +/- 430 g) were significantly lower in the study group compared with the control group. Numbers of preterm [<37 weeks; 14/55 (25%) versus 2/55 (4%); P = 0.002] and severe preterm (<34 weeks; 6/55 (11%) versus 0/55 (0%); P = 0.031] deliveries in the study group were significantly higher. There were no cases of perinatal mortality. Conisation affects obstetrical outcome after conisation for CIN. Babies tend to be born earlier and are smaller. It is not clear whether this is related to the procedure or to factors linked with CIN.

Outcome of pregnancy after laser conization: Implications for infection as a causal link with preterm birth

To investigate a causal link between infection and preterm birth in women with a shortened cervix induced by prior laser conization. We conducted a retrospective review of the outcomes of 47 singleton pregnancies with a history of laser conization. Cervical length was measured between 17 and 23 weeks of gestation. Receiver-operating characteristic curves were used to determine the best cut-off point for the cervical length for predicting spontaneous preterm birth. We measured infectious markers in 12 women who had experienced preterm labor. Nine women had had premature labors and three had had late abortions. The mean +/- SD cervical length was 33.1+/-9.1 mm. The optimal cut-off for predicting preterm delivery was 25 mm with a sensitivity and specificity of 75.0% and 97.1%, respectively. Concentrations of granulocyte elastase were positive in five of the six samples determined. The white blood cell count and C-reactive protein levels were elevated in four out of the six patients. Sixty-seven percent of the vaginal cultures were positive for bacteria. Chorioamnionitis was present in seven women. For the prediction of preterm birth in patients with a history of conization, it is helpful to look for signs of local infection when the cervical length is less than 25 mm.