REVIEW  UPDATES IN GYNECOLOGICAL MINIMALLY INVASIVE APPROACH AND MEDICAL THERAPY 

Minerva Obstetrics and Gynecology 2021 April;73(2):233-46

DOI: 10.23736/S2724-606X.20.04678-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Relationship between cervical excisional treatment for cervical intraepithelial neoplasia and obstetrical outcome

Marco MONTI, Debora D’ANIELLO ✉, Annalisa SCOPELLITI, Valentina TIBALDI, Giusi SANTANGELO, Vanessa COLAGIOVANNI, Andrea GIANNINI, Violante DI DONATO, Innocenza PALAIA, Giorgia PERNIOLA, Antonella GIANCOTTI, Ludovico MUZII, Pierluigi BENEDETTI PANICI

Department of Maternal and Child Health and Urological Sciences, Umberto I Hospital, Sapienza University, Rome, Italy

INTRODUCTION: The aim of our systematic review was the assessment of effects of excisional treatments for the management of cervical intraepithelial neoplasia (CIN) on preterm delivery (PD), lower birth weight (LBW), preterm premature rupture of membrane (PPROM) and obstetrical outcomes.
EVIDENCE ACQUISITION: A structured search was carried out in PubMed-Medline, Embase, and Cochrane Controlled Trials Register databases through November 30, 2019. The search included a combination of the following terms: “loop electrosurgical excision procedure (LEEP),” “large loop excision of transformation zone (LLETZ),” “cold-knife conization (CKC),” “laser cervical conization (CLC),” “preterm delivery” and “neonatal outcome.”
EVIDENCE SYNTHESIS: Thirty-two of 561 publications considered were included: 28 retrospective series, 2 prospective studies and 2 multicenter trials. Globally in several studies there was a significant increase in PD, measured by the relative risk, in the women underwent a surgical procedure for the CIN. In their majority, the studies were retrospective and therefore a high risk of bias.
CONCLUSIONS: This systematic review shows that the surgical treatment of the CIN was associated with an increased risk of PD, LBW and pPROM before 37 pregnancy weeks compared to untreated women, especially in a CKC and LLETZ procedure. Moreover, the increase of the of PD was associated with cone size, cervical length, repeated treatment and a short conization-to-pregnancy interval.

KEY WORDS: Cervical intraepithelial neoplasia; Papillomaviridae; Pregnancy