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Is the increased risk of preterm birth following excision for cervical intraepithelial neoplasia restricted to the first birth post treatment?

Editor’s comment: Prof. Jim Thornton: The increased risk of preterm birth after cervical excision is not restricted to the first birth after the procedure

It is well known that there is an increased risk of preterm birth after cervical excision procedures for CIN. The risk is predominantly after the deeper excisions. This paper shows that the increased risk affects later births as well as the first birth after the procedure.

Abstract
 

OBJECTIVE

To explore whether the increased risk of preterm birth following treatment for cervical disease is limited to the first birth following colposcopy.

DESIGN

Nested case-control study.

SETTING

Twelve NHS hospitals in England.

POPULATION

All nonmultiple births from women selected as cases or controls from a cohort of women with both colposcopy and a hospital birth. Cases had a preterm (20-36 weeks of gestation) birth. Controls had a term birth (38-42 weeks) and no preterm.

METHODS

Obstetric, colposcopy and pathology details were obtained.

MAIN OUTCOME MEASURES

Adjusted odds ratio of preterm birth in first and second or subsequent births following treatment for cervical disease.

RESULTS

A total of 2798 births (1021 preterm) from 2001 women were included in the analysis. The risk of preterm birth increased with increasing depth of treatment among first births post treatment [trend per category increase in depth, categories <10 mm, 10-14 mm, 15-19 mm, ≥20 mm: odds ratio (OR) 1.23, 95% confidence interval (95% CI) 1.12-1.36, P < 0.001] and among second and subsequent births post treatment (trend OR 1.34, 95% CI 1.15-1.56, P < 0.001). No trend was observed among births before colposcopy (OR 0.98, 95% CI 0.83-1.16, P = 0.855). The absolute risk of a preterm birth following deep treatments (≥15 mm) was 6.5% among births before colposcopy, 18.9% among first births and 17.2% among second and subsequent births post treatment. Risk of preterm birth (once depth was accounted for) did not differ when comparing first births post colposcopy with second and subsequent births post colposcopy (adjusted OR 1.15, 95% CI 0.89-1.49).

CONCLUSIONS

The increased risk of preterm birth following treatment for cervical disease is not restricted to the first birth post colposcopy; it remains for second and subsequent births. These results suggest that once a woman has a deep treatment she remains at higher risk of a preterm birth throughout her reproductive life.

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Commentaries by Editor Prof. Jim Thornton