| Background and ObjectiveIn recent years,with the continuous development and popularization of the Thinprep cytologic test(TCT),the human papillomavirus(HPV)combined cervical cancer screening technology,and the continuous improvement of women’s health awareness,the detection rate of cervical intraepithelial neoplasis(CIN)was significantly higher than before,and there was a clear trend towards youthfulness.Moreover,with the comprehensive implementation of the "second child" policy in China and the increasing number of women in late marriage and late pregnancy,more and more CIN patients have fertility requirements.Currently,At present,the treatment of cervical intraepithelial neoplasia common method is the cervical cone cut method,including the loop electrosurgical excision procedure(LEEP)、cold knife conization(CKC)and laser conization(LC),etc.The cervical cold knife cone cutting technique because of its cutting edge is clear,not heat effect and good for pathologic examination,is widely used in the treatment of cervical intraepithelial neoplasia grade III.Effective conization treatment can not only prevent the further development of cervical lesions,but also retain the fertility function of patients.Some scholarsbelieve that cervical cold knife conization removes a part of the cervical tissue,which can lead to increase the risk of adverse pregnancy outcomes such as premature rupture of membranes and premature birth.Some studies have found that the risk of adverse pregnancy outcomes(such as preterm birth,premature rupture of membranes)may be associated with cervical conization,but the effect of cone size on adverse pregnancy outcomes after cervical conization is still lack of exact data to support.In this article,the patients with pregnancy after cervical conization are studied.The aim is to analysis the related factors of preterm delivery and premature rupture of membranes after cervical conization,and to explore the predictive value of cone size for preterm birth,premature rupture of membranes.The critical value of cone size provides a scientific clinical basis for the development of a more reasonable size of cervical conization in the future.Materials and methods1.MaterialsMedical records of 314 cases of pregnant women with successful pregnancy and delivery who received cervix cold knife conization for treating cervical intraepithelial neoplasia grade III from January 2010 to June 2016 in the First Affiliated Hospital of Zhengzhou University(153 cases)and the Second Affiliated Hospital of Zhengzhou University(161 cases)was retrospectively analyzed.According to the gestational age,the patients were divided into preterm birth group(68 cases),and term birth group(246 cases);According to whether premature rupture of membranes occurred during pregnancy,the patients was divided into premature rupture of membranes(76cases)and premature unrupture of membranes(238 cases).Inclusion criteria:(1)Before admission,all the patients were confirmed to be grade III of cervical intraepithelial neoplasia by multiple biopsy of cervix under colposcopy or external biopsy and pathological consultation in both institutions;(2)There was no history of cervical insufficiency or bad pregnancy before operation;(3)All had the indication of cervical cold knife taper operation;(4)Single pregnancy;(5)Sign a letter of mutual consent;(5)There are no pregnancy-specific diseases and complications,such as pregnancy hypertension,gestational diabetes,placenta praevia and placental abruption.Pregnant women whose pregnancy ended in miscarriage and ectopicpregnancy were excluded.All patients were treated with cervical cold knife taper operation,and the indication and treatment of operation were consistent.2.MethodsThrough medical record collection and telephone follow-up,the data of age,the number of pregnancies,the number of deliveries,cone height and width,the duration of pregnancy,the interval of cervical conization to pregnancy,pregnancy syndrome,and pregnancy outcomes were studied.According to the interval of cervical conization to pregnancy,the date was divided into two groups,namely <12-month group and ≥12-month group.3.Statistical methodsStatistical analyses were performed using the computer software SPSS statistics version 17.0.Measurement data were expressed as t-test((?)±s),count data were compared by chi-square test.Multivariate analysis was performed by using multivariate logistic regression model.ROC curve was drawn to evaluate cone size to predict preterm birth and premature rupture of membranes.The value of P<0.05 was considered statistically significant.Results1.Analysis of the factors affecting preterm birth after cervical cold knife conizationThe relationship between cervical insufficiency,pregnancy interval(<12months),conization height and preterm birth after cervical conization was statistically significant(P<0.05).The incidence of preterm birth after cervical conization had nothing to do with the number of age,pregnancies,the number of deliveries,conization width(P>0.05).Multivariate logistic regression analysis showed that cervical insufficiency,pregnancy interval(<12 months),and conization height were closely related to preterm birth(P<0.05).All of which were high risk factors for preterm birth after cervical conization.2.Predictive value of cone size for preterm birth after cervical conizationWhen the critical value of conization height was 16.5mm,the area under the curve(AUC)was 0.765(95% CI: 0.674-0.856).which predicted the best value ofpreterm birth,sensitivity of 73.5% and specificity of 65%.The coniztion width was used as a predictor of preterm birth after cervical conization,and the area under the curve(AUC)was 0.580(p>0.05),which predicted the low efficiency of postoperative preterm delivery.3.Analysis of the factors affecting premature rupture of membranes after cervical cold knife conizationCervical insufficiency and conization height all affected the occurrence of premature rupture of membranes after cervical conization.The difference was statistically significant(P<0.05).They were risk factors for premature rupture of membranes after cervical conization.The interval of pregnancy(<12 months)had little effect on the occurrence of premature rupture of membranes(P>0.05).4.Predictive value of cone size for premature rupture of membranes after cervical conizationWhen the critical value of cervical conization height was 19.5mm,the area under the curve(AUC)was 0.738(95%CI: 0.674-0.856).which predicted the best value of premature rupture of membranes,sensitivity of 50% and specificity of 85.7%.The cone width was used to predict the ROC curve of premature rupture of membranes after cervical conization,and the area under the curve(AUC)was 0.578(p>0.05),which predicted the low efficiency of premature rupture of membranes.Conclusions1.The the cone height and postoperative pregnancy interval of cervical conization can affect pregnancy outcomes,the former was the risk factor of premature rupture of membranes,both were the risk factors of fetal preterm birth.2.When the cervical cone height is greater than 16.5 mm,it may increase the risk of postoperative preterm birth;when the cervical cone height is greater than 19.5mm,the risk of premature rupture of membranes will increase in postoperative.3.When the interval of pregnancy is less than 12 months,it may increase the risk of premature delivery and premature rupture of membranes. |
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