Excisional procedures for CIN2-3 do not increase the risk of preterm birth.

By , 2 April 2014

Excisional procedures for CIN2-3 do not increase the risk of preterm birth.

Pre-cancerous lesions of the cervix (i.e. CIN2-3), detected by Pap smear screening and confirmed by colposcopy and biopsy, and frequently treated by an excisional procedure such as a LLETZ or LEEP.  In women who have not yet completed their childbearing, these procedures have been thought to increase the risk of preterm birth, and this is factored into decision-making when choosing active treatment (excision) versus a "wait and see" approach (conservative).  Some previous studies have suggested that the changes to cervix's microstructure due to the disease process itself, and not the treatment procedure, may be the real cause of this risk of preterm birth.  This week a large meta-analysis of available evidence has been published in the journal Obstetrics & Gynecology.  Comparing >6'500 women who underwent a LLETZ/LEEP to women who have not, they confirmed this procedure is associated with an increase in the risk of birth before 37 weeks by about 60% (or an absolute risk increase of 3%).  However, when comparing to women who underwent a LLETZ/LEEP to women known to have dysplasia but managed without surgery, there was no difference in the rates of birth before 37 weeks.  This is the strongest evidence to date to suggest that LLETZ procedures may not be an independent risk for preterm birth, and this information will no doubt alter how we counsel women when deciding their treatment options.  

*(Data excluded laser and cone biopsies)

Article available here.

 

Excisional procedures for CIN2-3 do not increase the risk of preterm birth.
 

About Dr David Moore

Excisional procedures for CIN2-3 do not increase the risk of preterm birth.

David is a Fellow of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, and undertook his specialist training in Queensland.  He is highly skilled in the management of complex and high-risk pregnancies, and has special training in minimally-invasive surgery, endometriosis, pelvic floor and incontinence surgery.  David has completed a Master of Reproductive Medicine and is skilled in the assessment and management of fertility problems, and can offer the full range of assisted reproductive treatments.  He is a Senior Lecturer with The University of Queensland Medical School, and has published both medical journal and textbook contributions.

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