Jančar Nina, Mihevc Ponikvar Barbara, Tomšič Sonja
Department of Human Reproduction, Division of Obstetrics and Gynaecology, University Medical Centre Ljubljana, Slovenia.
Health Survey and Health Promotion Department, National Institute of Public Health, Ljubljana, Slovenia.
Eur J Obstet Gynecol Reprod Biol. 2016 Aug;203:245-9. doi: 10.1016/j.ejogrb.2016.06.005. Epub 2016 Jun 20.
Our aim was to explore the association between cold-knife conisation and large loop excision of transformation zone (LLETZ) with spontaneous preterm birth in a large 10-year national sample. We wanted to explore further the association of these procedures with preterm birth according to gestation.
We conducted a population based retrospective cohort study, using data from national Medical Birth Registry. The study population consisted of all women giving birth to singletons in the period 2003-2012 in Slovenia, excluding all induced labors and elective cesarean sections before 37 weeks of gestation (N=192730). We compared the prevalence of spontaneous preterm births (before 28 weeks, before 32 weeks, before 34 weeks and before 37 weeks of gestation) in women with cold-knife conisation or LLETZ compared to women without history of conisation, calculating odds ratios (OR), adjusted for potential confounders. Chi-square test was used for descriptive analysis. Logistic regression analyses were performed to estimate crude odds ratio (OR) and adjusted odds ratio (aOR) and their 95% confidence intervals (95% CI) with two-sided probability (p) values.
A total of 8420 (4.4%) women had a preterm birth before 37 weeks of gestation, 2250 (1.2%) before 34 weeks of gestation, 1333 (0.7%) before 32 weeks of gestation and 603 (0.3%) before 28 weeks of gestation. A total of 4580 (2.4%) women had some type of conisation in their medical history: 2083 (1.1%) had cold-knife conisation and 2498 (1.3%) had LLETZ. In women with history of cold-knife conisation, the adjusted OR for preterm birth before 37 weeks of gestation was 3.13 (95% CI; 2.74-3.57) and for preterm birth before 28 weeks of gestation 5.96 (95% CI; 4.3-8.3). In women with history of LLETZ, the adjusted OR was 1.95 (95% CI; 1.68-2.25) and 2.88 (95% CI; 1.87-4.43), respectively.
Women with cervical excision procedure of any kind have significantly increased odds for preterm birth, especially for preterm birth before 28 weeks and before 32 weeks of gestation.
我们的目标是在一个为期10年的全国性大样本中，探究冷刀锥切术和转化区大环形切除术（LLETZ）与自然早产之间的关联。我们想根据孕周进一步探究这些手术与早产之间的关联。
我们利用国家医疗出生登记处的数据进行了一项基于人群的回顾性队列研究。研究人群包括2003年至2012年期间在斯洛文尼亚生育单胎的所有女性，排除所有妊娠37周前的引产和择期剖宫产（N = 192730）。我们比较了有冷刀锥切术或LLETZ的女性与无锥切术史的女性中自然早产（妊娠28周前、32周前、34周前和37周前）的发生率，计算优势比（OR），并对潜在混杂因素进行调整。采用卡方检验进行描述性分析。进行逻辑回归分析以估计粗优势比（OR）和调整优势比（aOR）及其95%置信区间（95%CI）以及双侧概率（p）值。
共有8420名（4.4%）女性在妊娠37周前早产，2250名（1.2%）在妊娠34周前早产，1333名（0.7%）在妊娠32周前早产，603名（0.3%）在妊娠28周前早产。共有4580名（2.4%）女性有某种锥切术史：2083名（1.1%）有冷刀锥切术，2498名（1.3%）有LLETZ。有冷刀锥切术史的女性中，妊娠37周前早产的调整OR为3.13（95%CI：2.74 - 3.57），妊娠28周前早产的调整OR为5.96（95%CI：4.3 - 8.3）。有LLETZ史的女性中，调整OR分别为1.95（95%CI：1.68 - 2.25）和2.88（95%CI：1.87 - 4.43）。
任何类型宫颈切除术的女性早产几率显著增加，尤其是妊娠28周前和32周前的早产。
