Maguire Patrick J, McCarthy Claire M, Molony Peter, O'Donovan Eibhlis, Walsh Tom
Department of Gynaecology, Rotunda Hospital, Dublin 1, Ireland.
Department of Pathology, Rotunda Hospital, Dublin 1, Ireland.
Ir J Med Sci. 2019 May;188(2):579-581. doi: 10.1007/s11845-018-1893-z. Epub 2018 Aug 23.
The success of cervical screening relies on assessment and treatment of pre-malignant disease. Large loop excision of the transformation zone (LLETZ) has been the mainstay of treatment for cervical intraepithelial neoplasia (CIN). Preterm delivery (PTD) in subsequent pregnancy is a long-term complication of the intervention.
To describe the characteristics of women who had LLETZ treatment(s) followed by PTD in the Rotunda Hospital over a 10-year period.
The pathology and the obstetric databases were searched to identify women who had LLETZ followed by PTD from 1 January 2007-31 December 2016. Details including gestation at delivery, depth of LLETZ and grade of CIN were extracted. Exclusion criteria included multiple pregnancy, and deliveries due to current pregnancy indications.
There were 97 women eligible for inclusion. Mean gestation at delivery was 33 weeks. CIN 1 was diagnosed in 16, CIN 2 in 24, CIN 3 in 53, and four were negative for CIN. No microinvasive or invasive disease was identified. The average depth of excision was 9.9 mm, 11.4 mm and 8.5 mm for CIN 1, 2 and 3, respectively. The difference in depth between excisions with CIN 2 and 3 was significant (p = 0.019).
Despite having a lower mean depth of excision, women with CIN 3 comprised the majority of those who experienced PTD, suggesting that factors other than mechanical weakness are implicated in PTD for these women. This is in keeping with recent suggestions that the common denominator in high grade CIN and PTD is an altered vaginal microbiome.
宫颈筛查的成功依赖于对癌前病变的评估和治疗。转化区大环形切除术（LLETZ）一直是宫颈上皮内瘤变（CIN）的主要治疗方法。后续妊娠中的早产（PTD）是该干预措施的一种长期并发症。
描述在10年期间于罗顿达医院接受LLETZ治疗后发生PTD的女性的特征。
检索病理和产科数据库，以识别在2007年1月1日至2016年12月31日期间接受LLETZ治疗后发生PTD的女性。提取包括分娩时孕周、LLETZ深度和CIN分级等详细信息。排除标准包括多胎妊娠以及因当前妊娠指征而进行的分娩。
有97名女性符合纳入标准。分娩时的平均孕周为33周。16例诊断为CIN 1，24例为CIN 2，53例为CIN 3，4例CIN检查为阴性。未发现微浸润或浸润性疾病。CIN 1、2和3的平均切除深度分别为9.9毫米、11.4毫米和8.5毫米。CIN 2和3切除深度的差异具有统计学意义（p = 0.019）。
尽管平均切除深度较低，但CIN 3的女性占经历PTD的女性的大多数，这表明除机械性薄弱外的其他因素与这些女性的PTD有关。这与最近的观点一致，即高级别CIN和PTD的共同因素是阴道微生物群的改变。
