%0 Journal Article
%T Risk of Preterm Delivery Associated with Prior Treatment of Cervical Precancerous Lesion according to the Depth of the Cone
%A Roberto Berretta
%A Salvatore Gizzo
%A Andrea Dall¡¯Asta
%A Eleonora Mazzone
%A Michela Monica
%A Laura Franchi
%A Francesca Peri
%A Tito Silvio Patrelli
%A Alberto Bacchi Modena
%J Disease Markers
%D 2013
%R 10.1155/2013/686027
%X The aim of this study was to evaluate the impact of the surgical excisional procedures for cervical intraepithelial neoplasia (CIN) treatment both on subsequent fertility (cervical factor) and pregnancy complication (risk of spontaneous preterm delivery). We retrospectively analyzed 236 fertile women who underwent conization for CIN. We included in the study 47 patients who carried on pregnancy and delivered a viable fetus. Patients were asked about postconization pregnancies, obstetrical outcomes, and a possible diagnosis of secondary infertility caused by cervical stenosis. We evaluated the depth of surgical excision, the timing between cervical conization and subsequent pregnancies, surgical technique, and maternal age at delivery. We recorded 47 deliveries, 10 cases of preterm delivery; 8 of them were spontaneous. The depth of surgical excision showed a statistically significant inverse correlation with gestational age at birth. The risk of spontaneous preterm delivery increased when conization depth exceeded a cut-off value of 1.5£¿cm. Our data do not demonstrated a relation between conization and infertility due to cervical stenosis. 1. Introduction Cervical intraepithelial neoplasia (CIN) is defined as a series of intraepithelial changes which includes nuclear pleomorphism, loss of polarity, and presence of abnormal mitoses. It is confined to squamous epithelium, but it may shift from a benign to a malignant lesion [1]. The risk of cervical cancer in women older than 30 years with carcinoma in situ is estimated at 31% [2]. Although the great majority of all HPV-infections resolve spontaneously within the first 2 years, the subset of infection remained has a high-persistence potential [3]. Management guidelines therefore recommend treatment for women with moderate-to-severe dysplasia [4, 5]. Surgical techniques currently adopted by the majority of the practitioners consist in ablative or excisional approaches. The excisional approach usually performed by laser conisation or large loop excision of the transformation zone (LLETZ) or cold knife conisation, offers advantages over the ablative method both permitting the histological investigation of removed lesion and ensuring a greater excision of cervical transformation zone. Indeed, incomplete excisions or destruction of the transformation zone are an important indicator for patients at risk of treatment failure or disease recurrence [6]. Since the great majority of women with high-grade CIN are of reproductive age [7], it is important to not compromise future pregnancies by surgical interventions on
%U http://www.hindawi.com/journals/dm/2013/686027/