Risk Factors of Preterm Birth in Women After Local Treatment of Cervical Intraepithelial Neoplasia – a Retrospective Cohort Study

Abstract

Purpose A previous cervical intraepithelial neoplasia is associated with an increased obstetrical risk. It was the aim of the study to identify risk factors of preterm birth in patients with cervical intraepithelial neoplasia in dependence of the treatment modality (excisional vs. ablative).

Methods Women with treated cervical intraepithelial neoplasia and subsequent pregnancy (n = 155) were included in this retrospective study. Methods of treatment were either conization by large loop excision of the transformation zone (LLETZ) or ablative laser vaporization.

Results Of the total population 60.6% (n = 94) had a conization and 39.4% (n = 61) a laser vaporization alone. The frequency of preterm birth < 37 weeks was 9.7% (n = 15) without differences between conization and laser (11.7 vs. 6.7%, p = 0.407) with an odds ratio (OR) of 1.9 (95% confidence interval [CI] 0.6–6.2). Preterm birth < 34 weeks was found in 2.6% (n = 4), of which all had a conization (4.3 vs. 0%, p = 0.157). Risk factors for preterm birth were repeated cervical intervention (OR 4.7 [95% CI 1.5–14.3]), especially a combination of conization and laser ablation (OR 14.9 [95% CI 4.0–55.6]), age at intervention < 30 years (OR 6.0 [95% CI 1.3–27.4]), a history of preterm birth (OR 4.7 [95% CI 1.3–17.6]) and age at delivery < 28 years (OR 4.7 [95% CI 1.5–14.3]).

Conclusion The large loop excision of the transformation zone as a modern, less invasive ablative treatment did not obviously increase the risk of preterm birth compared to laser vaporization. The most important risk factor for preterm delivery was the need of a repeated intervention, especially at younger age. We assume that the persistence or recurrence of the cervical intraepithelial neoplasia following a high-risk human papillomavirus infection is mainly responsible for the observed effect.

Zusammenfassung

Zielsetzung Eine frühere intraepitheliale Neoplasie der Zervix wird mit einem höheren geburtshilflichen Risiko assoziiert. Ziel dieser Studie war es, die Risikofaktoren für eine Frühgeburt bei Patientinnen mit einer zervikalen intraepithelialen Neoplasie in der Anamnese zu identifizieren in Abhängigkeit von der Behandlungsmodalität (Exzision vs. ablative Behandlung).

Methoden In dieser retrospektiven Studie wurden Frauen aufgenommen, die zuvor wegen einer zervikalen intraepithelialen Neoplasie behandelt worden waren und danach schwanger wurden (n = 155). Die Behandlungsmethode bestand entweder aus Konisation mittels Schlingenexzision der Transformationszone (LLETZ) oder ablativer Laservaporisation.

Ergebnisse Von der Gesamtkohorte erhielten 60,6% (n = 94) eine Konisation und 39,4% (n = 61) eine Laservaporisation. Die Frequenz der Frühgeburten vor der 37. Schwangerschaftswoche betrug 9,7% (n = 15). Es gab keinen Unterschied zwischen Konisation und Laserbehandlung (11,7 vs. 6,7%, p = 0,407) mit einer Odds Ratio (OR) von 1,9 (95%-Konfidenzintervall [KI] 0,6–6,2). Eine Frühgeburt vor der 34. Schwangerschaftswoche trat bei 2,6% (n = 4) auf, und alle Betroffenen hatten zuvor eine Konisation erhalten (4,3 vs. 0%, p = 0,157). Risikofaktoren für eine Frühgeburt waren wiederholte zervikale Prozeduren (OR 4,7 [95%-KI 1,5–14,3]), vor allem eine Kombination aus Konisation und Laserablation (OR 14,9 [95%-KI 4,0–55,6]), Alter beim Eingriff < 30 Jahre (OR 6,0 [95%-KI 1,3–27,4]), Frühgeburt in der Anamnese (OR 4,7 [95%-KI 1,3–17,6]) sowie Alter bei der Entbindung < 28 Jahre (OR 4,7 [95%-KI 1,5–14,3]).

Schlussfolgerung Die Schlingenexzision der Transformationszone stellt eine moderne, weniger invasive ablative Behandlung dar, die offenkundig nicht das Risiko einer Frühgeburt erhöht verglichen mit der Laservaporisation. Der wichtigste Risikofaktor für eine frühgeburtliche Entbindung waren wiederholte Prozeduren zur Behandlung von Neoplasien, vor allem in jüngeren Jahren. Wir nehmen an, dass die Persistenz bzw. das Wiederauftreten einer zervikalen intraepithelialen Neoplasie nach einer Infektion mit einem Hochrisikoform des humanen Papillomavirus maßgeblich verantwortlich für die beobachtete Wirkung ist.

Schlüsselwörter

zervikale Dysplasie - LLETZ - Laservaporisation - Konisation - Frühgeburt - Risikoabwägung

Keywords

cervical dysplasia - LLETZ - laser vaporization - conization - preterm birth - risk assessment

Publication History

Received: 16 May 2022

Accepted after revision: 25 July 2022

Article published online:
08 November 2022

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