Department of Obstetrics and Gynecology, ULB Erasme Hospital, 808 Route de Lennik, 1070 Brussels, Belgium.
Eur J Obstet Gynecol Reprod Biol. 2012 May;162(1):16-20. doi: 10.1016/j.ejogrb.2012.01.019. Epub 2012 Feb 27.
Conization is the gold standard today for the management of severe cervical dysplasia. However, with the increasing delay until first pregnancy, obstetric follow-up of patients with a history of conization is a growing concern.
Retrospective case-control study using data from the electronic database of a university hospital. We compared the obstetric and neonatal outcome of 106 pregnancies delivered after conization with the outcome of 212 pregnancies of patients with no history of conization.
A significant reduction in the mean gestational age at delivery (38.23 ± 2.51 weeks vs. 39.15 ± 1.56 weeks) was observed, together with a higher rate of premature rupture of the membrane (9.4% vs. 1.9%), premature onset of labor (9.4% vs. 2.4%), premature delivery (17% vs. 3.8%) and neonatal hospitalization (17.9% vs. 6.6%) in the group of patients with history of conization. Children born to women who had surgery had a significantly lower birth weight (3146.9 ± 611 g vs. 3347.3 ± 502 g) and size (49.1 ± 2.6 cm vs. 50.0 cm ± 2.2 cm) than those of the control group. Furthermore, these children were more frequently admitted in the neonatal intensive care unit (22.6% vs. 10.4%, p=0.004).
Conization is an important risk factor for premature birth and women with a history of conization require cautious obstetric management during pregnancy. Anti-HPV vaccination and proactive surveillance of low-grade or moderate dysplasia, instead of immediate surgery, should be encouraged in young patients.
宫颈上皮内瘤变（CIN）的金标准治疗方法是锥切术。然而，随着首次妊娠年龄的推迟，行锥切术患者的产科随访问题日益突出。
采用大学医院电子数据库中的数据进行回顾性病例对照研究。我们比较了 106 例锥切术后妊娠患者与 212 例无锥切术史患者的产科和新生儿结局。
与无锥切术史组相比，锥切术后组的平均分娩孕周（38.23 ± 2.51 周 vs. 39.15 ± 1.56 周）显著缩短，且胎膜早破（9.4% vs. 1.9%）、早产临产（9.4% vs. 2.4%）、早产（17% vs. 3.8%）和新生儿住院（17.9% vs. 6.6%）的发生率较高。行锥切术的患者所生婴儿的出生体重（3146.9 ± 611 g vs. 3347.3 ± 502 g）和头围（49.1 ± 2.6 cm vs. 50.0 cm ± 2.2 cm）明显低于对照组。此外，这些婴儿更频繁地被收入新生儿重症监护病房（22.6% vs. 10.4%，p=0.004）。
锥切术是早产的重要危险因素，行锥切术的患者在妊娠期间需要谨慎的产科管理。应鼓励年轻患者接种 HPV 疫苗，并积极监测低级别或中级别上皮内瘤变，而不是立即手术。
