Kirn Verena, Geiger Pamina, Riedel Christina, Bergauer Florian, Friese Klaus, Kainer Franz, Knabl Julia
Department of Obstetrics and Gynecology, University of Cologne, Kerpener Str. 34, 50931, Cologne, Germany,
Arch Gynecol Obstet. 2015 Mar;291(3):599-603. doi: 10.1007/s00404-014-3463-6. Epub 2014 Sep 19.
Since the routine screening program for cervical dysplasia by Pap smear was established in the early 1970s, the rate of cervical cancer has continually dropped. Even if a high percentage of cervical dysplasia shows spontaneous restitution, the only effective therapy for persisting cervical dysplasia is local ablation or excision which might be associated with an increased risk of preterm delivery in subsequent pregnancies. However, data from German patients are missing, so the aim of this study was to evaluate the risk of preterm delivery and associated risks in a cohort of patients who had undergone cervical conisation previous to their pregnancies.
A total of 144 patients with conisation and subsequent pregnancy were identified. They were compared regarding week of delivery and preterm birth, fetal birth weight, fetal outcome and birth procedure (spontaneous delivery, vacuum extraction, primary and secondary cesarean section) with their matched partners.
135 patients with singleton pregnancies and their matched partners were evaluated in the final analysis. The mean age was 33.5 years. Comparing the case and control group we reached significant different results for week of delivery, but not preterm birth defined as birth prior to 37 weeks of gestation.
Within this German cohort cervical conisation did not increase the risk for preterm birth, cesarean section or poor fetal outcome. We therefore conclude that cervical conisation is an appropriate method to treat women with cervical dysplasia also at childbearing age when prevention of cervical cancer is needed.
自20世纪70年代初建立通过巴氏涂片进行宫颈发育异常的常规筛查项目以来，宫颈癌的发病率持续下降。即使高比例的宫颈发育异常表现为自然恢复，但对于持续存在的宫颈发育异常，唯一有效的治疗方法是局部消融或切除，而这可能会增加后续妊娠早产的风险。然而，缺少来自德国患者的数据，因此本研究的目的是评估一组在妊娠前接受宫颈锥切术的患者的早产风险及相关风险。
共确定了144例有锥切术及后续妊娠的患者。将她们与匹配的伴侣在分娩孕周、早产情况、胎儿出生体重、胎儿结局及分娩方式（自然分娩、真空吸引、初次及二次剖宫产）方面进行比较。
最终分析中评估了135例单胎妊娠患者及其匹配的伴侣。平均年龄为33.5岁。比较病例组和对照组，我们在分娩孕周方面得到了显著不同的结果，但在定义为妊娠37周前出生的早产方面没有差异。
在这个德国队列中，宫颈锥切术并未增加早产、剖宫产或不良胎儿结局的风险。因此我们得出结论，当需要预防宫颈癌时，宫颈锥切术也是治疗育龄期宫颈发育异常女性的一种合适方法。
