Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis
| dc.contributor.author | Kyrgiou, M. | en |
| dc.contributor.author | Koliopoulos, G. | en |
| dc.contributor.author | Martin-Hirsch, P. | en |
| dc.contributor.author | Arbyn, M. | en |
| dc.contributor.author | Prendiville, W. | en |
| dc.contributor.author | Paraskevaidis, E. | en |
| dc.date.accessioned | 2015-11-24T19:01:17Z | |
| dc.date.available | 2015-11-24T19:01:17Z | |
| dc.identifier.issn | 1474-547X | - |
| dc.identifier.uri | https://olympias.lib.uoi.gr/jspui/handle/123456789/19667 | |
| dc.rights | Default Licence | - |
| dc.subject | Adult | en |
| dc.subject | Birth Weight | en |
| dc.subject | Cervical Intraepithelial Neoplasia/*therapy | en |
| dc.subject | Conization | en |
| dc.subject | Delivery, Obstetric/statistics & numerical data | en |
| dc.subject | Female | en |
| dc.subject | Fertility | en |
| dc.subject | Humans | en |
| dc.subject | Infant, Newborn | en |
| dc.subject | Laser Therapy | en |
| dc.subject | Pregnancy | en |
| dc.subject | Pregnancy Complications, Neoplastic/*surgery | en |
| dc.subject | Pregnancy Outcome | en |
| dc.subject | Uterine Cervical Neoplasms/*surgery | en |
| dc.title | Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis | en |
| heal.abstract | 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. | en |
| heal.access | campus | - |
| heal.fullTextAvailability | TRUE | - |
| heal.identifier.primary | 10.1016/S0140-6736(06)68181-6 | - |
| heal.identifier.secondary | http://www.ncbi.nlm.nih.gov/pubmed/16473126 | - |
| heal.identifier.secondary | http://ac.els-cdn.com/S0140673606681816/1-s2.0-S0140673606681816-main.pdf?_tid=86e3bb1f5b17e4b68f0de0f0edd89e4d&acdnat=1333714148_6e7829a810f7b131cc637d8025695580 | - |
| heal.journalName | Lancet | en |
| heal.journalType | peer-reviewed | - |
| heal.language | en | - |
| heal.publicationDate | 2006 | - |
| heal.recordProvider | Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής | el |
| heal.type | journalArticle | - |
| heal.type.el | Άρθρο Περιοδικού | el |
| heal.type.en | Journal article | en |
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