Kyrgiou, M. and Koliopoulos, G. and Martin-Hirsch, Pierre L. and Arbyn, M. and Prendiville, W. and Paraskevaidis, E. (2006) Obstretric and fertility outcomes after conservative treatment for intra-epithelial or early invasive cervical lesions : systematic review and meta-analysis. The Lancet, 367 (9509). 489 - 498.Full text not available from this repository.
Background Conservative methods to treat cervical intraepithelial neoplasia and microinvasive cervical cancer are commonly used in young women because of the advent of effective screening programmes. In a meta-analysis, we investigated the effect of these procedures on subsequent fertility and pregnancy outcomes. Methods We searched for studies in MEDLINE and EMBASE and classified them by the conservative method used and the outcome measure studied regarding both fertility and pregnancy. Pooled relative risks and 95% CIs were calculated with a random-effects model and interstudy heterogeneity was assessed with Cochrane's Q test. Findings We identified 27 studies. Cold knife conisation was significantly associated with preterm delivery (<37 weeks; relative risk 2·59, 95% CI 1·80—3·72, 100/704 [14%] vs 1494/27 674 [5%]), low birthweight (<2500 g; 2·53, 1·19—5·36, 32/261 [12%] vs 905/13 229 [7%]), and caesarean section (3·17, 1·07—9·40, 31/350 [9%] vs 22/670 [3%]). Large loop excision of the transformation zone (LLETZ) was also significantly associated with preterm delivery (1·70, 1·24—2·35, 156/1402 [11%] vs 120/1739 [7%]), low birthweight (1·82, 1·09—3·06, 77/996 [8%] vs 49/1192 [4%]), and premature rupture of the membranes (2·69, 1·62—4·46, 48/905 [5%] vs 22/1038 [2%]). Similar but marginally non-significant adverse effects were recorded for laser conisation (preterm delivery 1·71, 0·93—3·14). We did not detect significantly increased risks for obstetric outcomes after laser ablation. Although severe outcomes such as admission to a neonatal intensive care unit or perinatal mortality showed adverse trends, these changes were not significant. Interpretation All the excisional procedures to treat cervical intraepithelial neoplasia present similar pregnancy-related morbidity without apparent neonatal morbidity. Caution in the treatment of young women with mild cervical abnormalities should be recommended. Clinicians now have the evidence base to counsel women appropriately.
|Journal or Publication Title:||The Lancet|
|Additional Information:||RAE_import_type : Journal article RAE_uoa_type : Allied Health Professions and Studies|
|Subjects:||R Medicine > R Medicine (General)|
|Departments:||Faculty of Science and Technology > Lancaster Environment Centre|
Faculty of Health and Medicine
|Deposited On:||05 Feb 2010 13:23|
|Last Modified:||26 Jul 2012 15:38|
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