Department of Obstetrics and Gynecology, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatsu, Miyazaki, Japan.
Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Japan.
Arch Gynecol Obstet. 2021 Oct;304(4):895-902. doi: 10.1007/s00404-021-06025-7. Epub 2021 Mar 19.
Laser vaporization of the cervix is an established method of treating cervical intra-epithelial neoplasia, but its effect on subsequent pregnancies remains controversial. The aim of this study was to investigate pregnancy outcomes after laser vaporization.
We conducted a retrospective study involving women who delivered live singletons between 2012 and 2019 in a tertiary hospital. The risks of adverse pregnancy outcomes after laser vaporization of the cervix were assessed using a multivariate regression model. The primary outcome was the adjusted odds ratio for preterm births. We also evaluated the course of labor progression, duration of labor, risk of emergency cesarean deliveries, and the risk of cervical laceration as secondary outcomes.
In total, 3359 women were analyzed in this study. The risk of preterm birth was significantly higher in pregnancies after laser vaporization of the cervix (adjusted odds ratio [AOR] 1.84, 95% confidence interval [95% CI] 1.06-3.20; p = 0.030). The duration of the first stage of labor was significantly shorter in the post-treatment group (median 255 min vs. 355 min; p = 0.0049). We did not observe significant differences in the duration of the second stage of labor (median 21 min vs 20 min; p = 0.507) or the rates of other obstetric events, including emergency cesarean deliveries (AOR 0.736; 95% CI 0.36-1.50; p = 0.400) and cervical laceration (AOR 0.717; 95% CI 0.22-2.35; p = 0.582).
Laser vaporization of the cervix is associated with an increased risk of preterm births and a shorter duration of the first stage of labor in subsequent pregnancies. Careful consideration is necessary when selecting a method of treatment for the uterine cervix of patients wishing future pregnancies.
宫颈激光汽化术是治疗宫颈上皮内瘤变的一种成熟方法，但它对后续妊娠的影响仍存在争议。本研究旨在探讨宫颈激光汽化术后的妊娠结局。
我们进行了一项回顾性研究，纳入了 2012 年至 2019 年在一家三级医院分娩的活单胎产妇。使用多变量回归模型评估宫颈激光汽化术后不良妊娠结局的风险。主要结局是早产的调整比值比。我们还评估了产程进展、产程持续时间、紧急剖宫产的风险和宫颈裂伤的风险作为次要结局。
本研究共分析了 3359 名妇女。宫颈激光汽化术后妊娠早产的风险显著升高（调整比值比 [AOR] 1.84，95%置信区间 [95%CI] 1.06-3.20；p=0.030）。治疗后组第一产程持续时间明显缩短（中位数 255 分钟比 355 分钟；p=0.0049）。我们没有观察到第二产程持续时间（中位数 21 分钟比 20 分钟；p=0.507）或其他产科事件（包括紧急剖宫产 [AOR 0.736；95%CI 0.36-1.50；p=0.400] 和宫颈裂伤 [AOR 0.717；95%CI 0.22-2.35；p=0.582]）的发生率有显著差异。
宫颈激光汽化术与后续妊娠早产风险增加和第一产程持续时间缩短有关。在为希望未来妊娠的患者选择宫颈治疗方法时，需要仔细考虑。
