Department of Metabolism, Digestion and Reproduction, Department of Surgery and Cancer, IRDB, Imperial College London, London, UK; Department of Obstetrics & Gynaecology, Imperial Healthcare NHS Trust, London, UK.
Department of Metabolism, Digestion and Reproduction, Department of Surgery and Cancer, IRDB, Imperial College London, London, UK; Department of Obstetrics & Gynaecology, Imperial Healthcare NHS Trust, London, UK.
Best Pract Res Clin Obstet Gynaecol. 2021 Sep;75:10-22. doi: 10.1016/j.bpobgyn.2021.05.007. Epub 2021 Jun 2.
The awareness that cervical intra-epithelial neoplasia (CIN) treatment increases the risk of preterm birth has led to major changes in clinical practice. Women with CIN have a higher baseline risk of prematurity but local treatment further increases this risk. The risk further increases with increasing cone length and multiplies for repeat excisions; it is unclear whether small cones confer any additional risk to CIN alone. There is no evidence to suggest that fertility is affected by local treatment, although this increases the risk of mid-trimester loss. Caution should prevail when deciding to treat women with CIN of reproductive age. If treatment is offered, this should be conducted effectively to optimise the clearance of disease and minimise the risk of recurrence. Colposcopists should alert women undergoing treatment that this may increase the risk of preterm birth and that they may be offered interventions when pregnant. The cone length should be clearly documented and used as a risk stratifier.
人们已经意识到宫颈上皮内瘤变（CIN）的治疗会增加早产的风险，这导致了临床实践的重大变化。患有 CIN 的女性本身就有更高的早产基础风险，但局部治疗会进一步增加这种风险。锥切长度的增加会进一步增加风险，重复切除会使风险倍增；目前尚不清楚小锥切是否会给单纯的 CIN 带来任何额外风险。没有证据表明局部治疗会影响生育能力，尽管这会增加中期流产的风险。在决定是否治疗有生育能力的育龄期妇女的 CIN 时，应谨慎行事。如果提供治疗，应有效地进行治疗，以优化清除疾病，并将复发风险降到最低。行治疗的患者，应告知其这可能增加早产的风险，并在怀孕期间为其提供干预措施。应明确记录锥切长度，并将其用作风险分层的指标。
