Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, Nigeria.
Center for Translation and Implementation Research, College of Medicine, University of Nigeria Nsukka, Abakaliki, Nigeria.
Niger J Clin Pract. 2024 Feb 1;27(2):215-220. doi: 10.4103/njcp.njcp_624_23. Epub 2024 Feb 26.
Treatment of cervical pre-cancers involves ablative and excisional therapies, and these have the potential to affect future pregnancy outcomes of women. Understanding the impact of the various treatment modalities on the outcome of pregnancies can motivate the development of interventions to improve pregnancy outcomes in women who had cervical pre-cancer treatment.
We aimed to the effect of cervical pre-cancer treatment on second-trimester miscarriages and preterm births.
Matched case-control study in which 373 women who had a pregnancy after cervical pre-cancer treatment were matched with 373 controls. McNemar Chi-square was used to compare the prevalence of second-trimester miscarriage and preterm birth between the study group and the matched controls. Conditional logistic regression analysis was done to determine the risk factors for second-trimester miscarriage and preterm birth.
Second-trimester miscarriages and preterm births were higher in women who had cervical pre-cancer treatment (AOR: 2.05, 95% CI: 1.174 - 3.693, p: 0.01) and (AOR: 2.74, 95% CI: 1.591 - 4.902, p: 0.0001) respectively. In addition, large loop excision of the transformation zone (LLETZ) of the cervix increased the odds of second-trimester miscarriage (AOR: 1.22, 95% CI: 1.034 - 1.441, p: 0.019) and preterm birth (AOR: 2.98, 95% CI: 1.793 - 3.965, p: 0.001). Cryotherapy and thermocoagulation were not associated with increased miscarriage and preterm birth. Treatment to pregnancy interval of ≥ 12 months decreased the odds of second-trimester miscarriage (AOR: 0.605, 95% CI: 0.502 - 0.808, p: 0.031) and preterm birth (AOR: 0.484, 95% CI: 0.317 - 0.738, p: 0.001).
There is an increased odds of second-trimester miscarriage and preterm birth in women treated with LLETZ. A treatment-to-pregnancy interval of ≥ 12 months reduces this odd. Ablative therapies do not increase the odds of miscarriages and preterm births. This information could guide decisions on the choice of method of treatment for cervical pre-cancer in women of childbearing age.
宫颈前病变的治疗包括消融和切除术，这些治疗方法有可能影响女性未来的妊娠结局。了解各种治疗方法对妊娠结局的影响，可以促使开发干预措施来改善接受过宫颈前病变治疗的女性的妊娠结局。
研究宫颈前病变治疗对中期流产和早产的影响。
本研究采用病例对照匹配研究，对 373 名接受宫颈前病变治疗后妊娠的妇女进行研究，将她们与 373 名对照匹配。采用 McNemar 卡方检验比较研究组与匹配对照组中中期流产和早产的发生率。采用条件逻辑回归分析确定中期流产和早产的危险因素。
接受宫颈前病变治疗的妇女中，中期流产和早产的发生率更高（AOR：2.05，95%CI：1.174-3.693，p：0.01）和（AOR：2.74，95%CI：1.591-4.902，p：0.0001）。此外，宫颈环形电切术（LLETZ）增加了中期流产的几率（AOR：1.22，95%CI：1.034-1.441，p：0.019）和早产（AOR：2.98，95%CI：1.793-3.965，p：0.001）。冷冻疗法和热凝疗法与流产和早产发生率增加无关。治疗与妊娠间隔时间≥12 个月降低了中期流产的几率（AOR：0.605，95%CI：0.502-0.808，p：0.031）和早产的几率（AOR：0.484，95%CI：0.317-0.738，p：0.001）。
LLETZ 治疗的女性中期流产和早产的几率增加。治疗与妊娠间隔时间≥12 个月可降低这种几率。消融治疗不会增加流产和早产的几率。这些信息可以指导在生育年龄女性中选择宫颈前病变治疗方法的决策。
