Wuntakal R, Castanon Alejandra, Landy R, Sasieni P
Whipps Cross University Hospital, Barts Health NHS Trust, London, England, UK.
Guys and St Thomas' Hospital, London, England, UK.
BMC Pregnancy Childbirth. 2015 Sep 29;15:232. doi: 10.1186/s12884-015-0664-3.
Preterm births (as a proportion of all births) have been increasing in many countries. There is growing evidence of increased risk of preterm birth following excisional treatment of the cervix. We estimate the number of preterm births attributable to excisional treatments with a length of 10 mm or more in England.
Case-control study nested in a record linkage cohort of women with a histological sample at 13 hospitals in England. We combined observed age at first excisional treatment in our cohort with the weighted distribution of excision length from the case-control study to estimate the length distribution by age at first treatment among the cohort. The number of births after excision for each 5-year age group was estimated using national fertility data; published absolute risks of preterm (<37 gestational weeks) and very preterm birth (<32 weeks) were applied to these to estimate the number of preterm births per 100 women treated. Excess preterm births were estimated assuming all treatments were small. The attributable risk of preterm birth following excisional treatment in England was estimated.
The majority of first excisional treatments at colposcopy were small (47.5%) or medium (39.1%), 9.5% were large and 4.1% were very large excisions. 4.0% of women treated before birth had more than one excisional treatment. Thus based on our cohort of 10,711 treated women and the length of treatment observed in the case control study we estimate an excess of 240 preterm births (including 57 very preterm) or 2.2 (including 0.5 very preterm) per 100 women treated. At a population level (for England) we estimate that 39,101 women aged 20-39 would be treated each year and that these treatments will lead to an excess of 840 preterm births (including 196 very preterm) in England each year.
Assuming associations between preterm birth and treatment for cervical disease are causal; we estimate that an excess 840 (2.5%) preterm birth in England each year are due to excisional treatments of 10 mm or more. Those that go on to become pregnant should be closely monitored during antenatal period to reduce their risk of preterm birth.
在许多国家，早产（占所有分娩的比例）一直在增加。越来越多的证据表明，宫颈切除术后早产风险增加。我们估计了在英格兰因长度为10毫米或更长的切除治疗导致的早产数量。
病例对照研究嵌套在英格兰13家医院的组织学样本女性记录链接队列中。我们将队列中首次切除治疗时观察到的年龄与病例对照研究中切除长度的加权分布相结合，以估计队列中首次治疗时按年龄划分的长度分布。使用国家生育数据估计每个5岁年龄组切除术后的出生数量；将已发表的早产（孕周<37周）和极早产（孕周<32周）的绝对风险应用于这些数据，以估计每100名接受治疗的女性中的早产数量。假设所有治疗规模较小，估计额外的早产数量。估计了英格兰切除治疗后早产的归因风险。
阴道镜检查时的大多数首次切除治疗规模较小（47.5%）或中等（39.1%），9.5%为大型，4.1%为超大型切除。4.0%在出生前接受治疗的女性有不止一次切除治疗。因此，基于我们的10711名接受治疗的女性队列以及病例对照研究中观察到的治疗长度，我们估计每100名接受治疗的女性中额外有240例早产（包括57例极早产）或2.2例（包括0.5例极早产）。在人群层面（针对英格兰），我们估计每年有39101名20至39岁的女性接受治疗，这些治疗每年将在英格兰导致额外840例早产（包括196例极早产）。
假设早产与宫颈疾病治疗之间的关联是因果关系；我们估计，在英格兰，每年有额外840例（2.5%）早产是由于10毫米或更长的切除治疗所致。那些继续怀孕的女性在孕期应密切监测，以降低早产风险。
