Meta-analysis Of The Effect Of Cervical Conectomy On Pregnancy And Pregnancy Outcome

Objective:A meta-analysis was conducted to explore the difference between Loop electrosurgical excision procedure(LEEP)and Cold knife conization(CKC)on pregnancy and pregnancy outcome.Methods:A case-control study or cohort study on the effect of LEEP and/or CKC on pregnancy and pregnancy outcome published in CNKI,Wanfang Database,China Biomedical Database(CBM)and Pub Med database from January 1,2002 to December 31,2021 was searched.The included literature was screened,evaluated,extracted data,analyzed data and drawn conclusions.Review Manage5.4 software was used for data analysis.Continuity variables were represented by mean difference(MD)and 95%confidence interval(CI),and dichotomous variables were represented by odds ratio(OR)and 95%CI.Heterogeneity was tested by I~2.I~2≤50%was homogenous,and fixed effect model was used to analyze data.I~2>50%,indicating large heterogeneity.Further analysis was made on the source of heterogeneity.If there was heterogeneity,the data were analyzed by fixed-effect model.If there was no source of heterogeneity,the data were analyzed using a random-effects model.Forest plot was used to represent the results of meta-analysis,and funnel plot was used to represent the results of publication bias analysis(≥7 articles were included,funnel plot was drawn;<7,which were considered to have a large publication bias and were not described).Results:A total of 736 references were retrieved,and 48 were finally included,with a total sample size of 102181 cases.The results show:the OR and 95%CI of pregnancy,spontaneous abortion,premature delivery,premature rupture of membranes,cervical laceration,low birth weight of newborn,cesarean delivery in CKC group and control group were 0.62(0.44-0.87)、3.15(1.96-5.06)、3.43(2.55-4.61)、2.41(2.02-2.89)、10.17(4.45-23.28)、3.08(2.11-4.4.9)、2.68(1.43-5.02).The OR and 95%CI of pregnancy,ectopic pregnancy,spontaneous abortion,premature delivery,premature rupture of membranes,cervical laceration,postpartum hemorrhage,low birth weight of newborn,cesarean delivery in LEEP group and control group were 0.80(0.61-1.04)、0.95(0.34-2.65)、1.18(0.90-1.55)、1.60(1.28-2.00)、1.43(1.17-1.74)、1.81(1.10-2.96)、0.94(0.51-1.75)、2.23(1.67-2.97)、0.35(-0.09-0.79)、1.54(1.02-2.33).The OR and 95%CI of pregnancy,ectopic pregnancy,spontaneous abortion,premature delivery,premature rupture of membranes,cervical laceration,low birth weight of newborn,cesarean delivery in LEEP group and CKC group were 1.52(1.07-2.17)、0.61(0.18-2.03)、0.55(0.30-1.01)、0.41(0.28-0.60)、0.49(0.31-0.76)、0.46(0.23-0.92)、0.39(0.25 0.61)、0.95(0.73-1.24).Conclusion:CKC and LEEP increase the risk of premature delivery,premature rupture of membranes,cervix laceration,low birth weight and cesarean section rate.After CKC,pregnancy rate decreases and the risk of spontaneous abortion increases.LEEP does not increase the risk of ectopic pregnancy,spontaneous abortion and postpartum hemorrhage,and has no effect on labor and pregnancy.The risk of premature delivery,premature rupture of membranes,cervical laceration and low birth weight after LEEP was lower than that after CKC.When fertility requires women to undergo cervical conectomy,preoperative communication should be sufficient and LEEP should be implemented as far as possible.Pregnancy should be guided after cervical conectomy,assisted reproductive technology should be adopted when necessary,management should be strengthened during pregnancy,and indications for cesarean section should be relaxed appropriately.