| Research Background: Cervical cancer is one of the most common malignancies in the female reproductive system.Cervical intraepithelial neoplasia(CIN)is a group of precancerous lesions closely related to cervical cancer and is divided into CIN I,II,and III according to the cellular atypism.With the popularity of cervical cancer screening and increase of late marriage,late childbearing and premarital sex women,more and more unmarried women are diagnosed as high-grade CIN,that is CIN II-III.And CIN II-III is the critical stage of prevention and treatment for cervical cancer.Cervical conization has been widely used in clinical practice for those who are diagnosed with high-grade CIN and have fertility requirements in recent years.There are two main ways including cervical electrosurgical procedure(LEEP)and cold knife conization(CKC)to treat high-grade CIN based on its level,lesion range,age and compliance.LEEP use high-frequency electric knife to complete a variety of cutting and bleeding.CKC is the traditional way of treating CIN.General resection extension include cervical lesions and part of the neck tissue.Complications include bleeding,infection and cervical stenosis.But whether it will affect the long-term pregnancy need to be explored.How long is the appropriate postoperative interval? What is the different effect of different conization on pregnancy outcome?Objective: 1.It is a retrospective cohort study.Women with cervical conization due to CIN II-III who filed in our hospital were enrolled.Collect the previous surgical conditions and pregnancy-related information.While collect the basic situation and pregnancy outcome of the normal control during the same period.To explore the effect of different cervical conization on pregnancy outcome,mode of delivery and perinatal outcome.2.To explore the effect of different pregnancy interval on pregnancy outcome after high grade cervical lesions.Methods: Women with cervical conization(including LEEP or CKC)due to high-grade cervical lesions(CIN II-III)who filed and delivered in Beijing Obstetrics and Gynecology Hospital between January 2010 and December 2015 were enrolled.60 cases were collected.According to the ratio of 1:2,select 120 cases without cervical conization history who filed and delivered in Beijing Obstetrics and Gynecology Hospital randomly as the normal control group.The following data were collected: general information about patients such as age,height,pre-pregnancy weight,prepregnancy body mass index(BMI),gestational weight gain,pregnancy history,menstrual history,smoking and drinking history;delivery mode such as vaginal delivery,cesarean section(CS);pregnancy outcome(miscarriage / preterm birth,full term,premature rupture of membranes);Postpartum Hemorrhage(PPH);neonatal condition(birth weight,neonatal length,Apgar score).Analyze the effect of different surgical methods and gestational interval on the outcome of pregnancy.All date were analyzed in SPSS version 22.0.Quantitatve variables following normal distribution were expressed by mean ± standard deviation.In the multi-group comparison,quantitative variables following normal distribution were compared by one-way ANOVA.Quantitative variables not following normal distribution were compared by Kruskal-Wallis rank test.If the results were statistically significant(P <0.05),Bonferroni or LSD was used to compare each two group.Qualitative variables were expressed by relative frequency.Qualitative variables were compared by Chi-square test,Continuity Correction or Fisher’s exact test.The multiple-rate comparison is LSD or Bonferroni method.In the multi-group comparison,LSD or Bonferroni methods were used.Statistical significance was determined at P<0.05.Results: 1.The effect of different conization of the surgical on pregnancy outcome 1).General comparison The age of control group was significantly lower than that of LEEP group and CKC group(29.8 ± 3.3 vs 31.7 ± 2.7,P = 0.01;29.8 ± 3.3 vs 31.3 ± 3.7,P = 0.02).There was no signifinantly differences between LEEP group and CKC group(P> 0.05).There was no significant statistical differences among other general situation,such as height,pre-pregnancy weight,BMI,maternal history,smoking,drinking history and menstrual history 2).Comparison of pregnancy outcome and obstetric complications The abortion rate in the control group(4.2%)was lower than that of LEEP(13.0%)and CKC groups(12.1%),but the difference was not statistically significant(P> 0.05).In the control group,26.7%(32 cases)has premature rupture of membranes,which was lower than that in LEEP and CKC group(34.8%,21.6%),the difference was not statistically significant(P> 0.05).There was no significant difference in the amount of postpartum hemorrhage,the incidence of amniotic fluid embolism and the rate of uterine rupture during the three groups(P> 0.05).3).The impact on the mode of delivery The rate of cesarean section in the control group was 24.2%,and the rate of cesarean section in LEEP and CKC group was 43.5%(n = 10)and 64.9%(n = 24),the difference was statistically significant(P <0.05).The rate of cesarean section in CKC group was significantly higher than that in normal control group(64.9% vs 24.2%),the difference was statistically significant(P <0.05).The operative rate of vaginal delivery in LEEP and CKC was 7.7%(n = 1)and 48.5%(n = 1).There is 5.5%(n = 5)operative of vaginal delivery patients in the control group.There was a statistically significant difference in operative rate among the three groups(P <0.05).The operative rate in the CKC group was significantly higher than that in the normal control group(P <0.05).4).Impact on perinatal outcomes There was no significant statistical difference on neonatal(low birth weight,neonatal length,Apgar score)among different conization surgery and normal control group.2.The impact of different pregnancy interval on pregnancy outcome.1).General comparison There were no significant differences in height,age,pre-pregnancy weight,prepregnancy body mass index,gestational weight gain,gestational age,menstrual period,menstrual period,menstrual period,smoking and drinking history.The difference was not statistically significant(P> 0.05).2).Comparison of pregnancy outcomes among different gestational intervals There is no preterm birth in pregnancy interval≤6 months group,2 cases in pregnancy interval 6 to 12 months group(18.2%)and 5cases in 42 cases pregnancy interval>12 months group(11.9%),the difference was no statistical significance(P> 0.05).The rate of premature rupture of membranes in pregnancy interval≤6 months group was 14.3%(n = 3),and that in pregnancy interval 6 to 12 months group was 27.3%(n = 3),The rate of premature rupture of membranes in the pregnancy interval >12 months group was 28.6%(n = 12).There was no significant difference among the three groups(P> 0.05).3).Effect on delivery mode and perinatal outcome The rate of cesarean section in pregnancy interval ≤ 6 months group was 28.6%.The rate of cesarean section in pregnancy interval 6 to 12 months was 72.7%.The rate of cesarean section in pregnancy interval>12 months group was 57.1%.There were no statistical significance among three groups(P> 0.05).There were 5 cases successful vaginal delivery pregnancy interval ≤ 6 months group.The rate of operative was 80%(n = 4).The rate of operative was 33.3% in pregnancy interval 6 to 12 months group(n = 1).The rate of operative was 5.6% in pregnancy interval> 12 months group(n = 1).There were statistical differences(P <0.05)The operative rate in the vaginal trial in≤6month group was significantly higher than that in the 12 months(80% vs 5.6%,P <0.05).The rate of low birth weight infants in pregnancy interval≤6 months group was 14.3%.The rate of low birth weight infants in pregnancy interval 6 to 12 months group was 0%(n = 0).The rate of low birth weight infants in pregnancy interval pregnancy interval> 12 was 9.5%(n = 4),the results were not statistically significant(P> 0.05).Conclusion: 1.Cervical conization can not increase the rate of abortion / premature birth and the rate of premature rupture of membranes.2.Different cervical conization had no significant effect on adverse perinatal outcome.3.Cervical conization can increase the rate of cesarean section(CS)and operative rate of vaginal delivery,LEEP had no significant effect on cesarean section rate and operative rate of vaginal delivery.4.The extension pregnancy interval of cervical conization surgery can reduce the rate of surgical delivery in vaginal delivery. |
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