Cervical Conization and the Future Risk for Preterm Labor and Cesarean Delivery

Little is known about the mechanism and biochemical pathway of preterm delivery. Some drugs used to treat preterm labor are also useful for the treatment of primary dysmenorrhea. This study attempted to evaluate the association between primary dysmenorrhea and preterm delivery from an epidemiological perspective. A nested case-control study was conducted; 329 singleton preterm delivery cases were investigated, in aggregate and in subgroups (spontaneous preterm labor and preterm premature rupture of membranes). Concurrently, 329 singleton gravid women with term delivery served as controls. Medical charts and records provided information about the maternal history of dysmenorrhea, index pregnancy outcome, and demographic characteristics. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the multiple logistic regression method. Gravid women with a history of primary dysmenorrhea had no more risk of preterm delivery than those without a history of primary dysmenorrhea (adjusted OR, 1.16; 95% CI, 0.95 to 2.19; p=0.37). However, for subgroup analysis, gravid women with severe primary dysmenorrhea were associated with an adjusted 2.73-fold risk of spontaneous preterm delivery (95% CI, 1.49 to 4.95; p=0.02), and with an adjusted 1.51-fold risk of preterm premature rupture of membranes (95% CI, 0.68 to 3.22; p=0.31). Severe primary dysmenorrhea is associated with an increased risk of spontaneous preterm delivery. A common pathophysiologic pathway may exist between these two disorders. Further in-depth biochemical and molecular studies are necessary to explore this phenomenon.

To evaluate the risk of preterm delivery in patients with adenomyosis. A 1:2 nested case-control study. Tertiary-care institution. A base cohort population of 2138 pregnant women who attended routine prenatal check-up between July 1999 and June 2005. From this base cohort population, gravid women with singleton pregnancy who delivered prior to the completion of 37 weeks of gestation were identified and formed the study group. Singleton gravid women who had term delivery and who matched with age, body mass index, smoking, and status of previous preterm delivery were recruited concurrently and served as control group. Preterm delivery cases were further divided into spontaneous preterm delivery and preterm premature rupture of membranes (PPROM) cases. Risk analysis of preterm delivery between gravid women with and without adenomyosis. One-hundred and four preterm delivery case subjects and 208 control subjects were assessed. Overall, gravid women with adenomyosis were associated with significantly increased risk of preterm delivery (adjusted odds ratio 1.96, 95% CI 1.23-4.47, P=0.022). For subgroup analysis, gravid women with adenomyosis had an adjusted 1.84-fold risk of spontaneous preterm delivery (95% CI 1.32-4.31, P=0.012) and an adjusted 1.98-fold risk of PPROM (95% CI 1.39-3.15, P=0.017). Gravid women with adenomyosis were associated with increased risk of both spontaneous preterm delivery and PPROM. A common pathophysiological pathway may exist in these two disorders. Further in-depth biochemical and molecular studies are necessary to explore this phenomenon.

To investigate the effect of laser conisation of the cervix on the outcome of subsequent pregnancy. Case-control study. Department of Obstetrics & Gynaecology, University Hospital, Trondheim, Norway. Three hundred and fifty-one women were treated for cervical intra-epithelial neoplasia (CIN) by laser conisation of the cervix between 1 January 1983 and 31 December 1985. The 56 women among them who had been delivered of live infants beyond 22 weeks gestation after the conisation and before 1 January 1991 were studied for the outcome of their pregnancies. For each case, two controls of equal parity and age (+/- 3 years) were selected. The length of gestation and birthweight of the infants. The median (range) length of gestation was 39 weeks (26-43) in cases compared with 40 weeks (34-42) in controls (z = -4.0, P < 0.001). The median (range) birthweight was 3330 g (1150-4940) in cases and 3630 g (1610-5080) in controls (z = -3.5, P < 0.001). Overall 38% of cases were delivered preterm (< or = 37 weeks gestation), compared with 6% of controls (P < 0.0001; odds ratio 9.0, 95% CI 3.7-21.7). A logistic regression analysis of a set of possible confounding factors revealed no significant risk factors in addition to conisation for the occurrence of preterm delivery. No correlation was found between the height of the cone and the occurrence of preterm delivery in subsequent pregnancy. Conisation with microsurgical laser technique increases the risk of preterm delivery in subsequent pregnancies. Laser conisation in young women should be restricted to those with high grade CIN or a lesion extending into the endocervical canal.

To assess the effect of cervical conisation on pregnancy outcome, a literature search strategy was conducted to identify all of the references lists of the relevant studies. The fixed or random effect model was used to calculate pooled RRs on the basis of heterogeneity. Twenty-seven publications with n cases and m controls were included in the meta-analysis. The results showed that conisation was associated with a higher risk of a preterm delivery (p = .010), PROM (p = .008), and a lower birth weight (p < .001) in overall effect. The subgroup analysis showed that CKC was associated with a significantly increased risk of a preterm delivery (p < .001), and a lower birth weight (p< .001). LLETZ was associated with preterm delivery (p = .004) and a lower birth weight (p = .020). The results suggested that cervical conisation increases the risk of a preterm delivery, PROM, and a lower birth weight, especially in a CKC and LLEETZ procedure.Impact statementWhat is already known on this subject? Currently, the three main excisional procedures for cervical intraepithelial neoplasia (CIN) treatment are laser conisation, cold-knife conisation (CKC), and a large loop excision of the transformation zone (LLETZ). CKC and LEEP/LLETZ were significantly associated with a preterm delivery and low birth weight, and that former was associated with higher relative risks than the latter one.What do the results of this study add? The present results showed that conisation was associated with a higher risk of a preterm delivery, PROM, and a lower birth weight in overall effect. A subgroup analysis showed that CKC was associated with a significantly increased risk of a preterm delivery, and a lower birth weight. LLETZ was associated with a preterm delivery and lower birth weight.What are the implications of these findings for clinical practice and/or further research? This study is of clinical significance by showing that cervical conisation increases the risk of preterm delivery, PROM, and a lower birth weight, especially in a CKC and a LLEETZ procedure.

Previous preterm delivery and maternal smoking are associated with increased risks of preterm delivery. It is not known whether gestational age at the time of a preterm delivery is correlated with gestational age in successive preterm deliveries and whether changes in smoking habits influence the subsequent risk of preterm delivery. We studied the associations among smoking habits, previous very preterm or moderately preterm delivery (before 32 weeks and at 32 to 36 weeks, respectively), and the risk of a subsequent very preterm or moderately preterm delivery in a population-based cohort of 243,858 women in Sweden between 1983 and 1993. The results were adjusted for covariates known to be associated with preterm delivery. The odds ratios for very or moderately preterm delivery in a subsequent pregnancy among women with a previous very preterm delivery, as compared with women who had a previous term delivery, were 12.4 (95 percent confidence interval, 9.1 to 17.0) and 7.1 (95 percent confidence interval, 6.0 to 8.4), respectively. Among women with a previous moderately preterm delivery, the corresponding odds ratios were 2.3 (95 percent confidence interval, 1.9 to 3.0) and 5.9 (95 percent confidence interval, 5.5 to 6.3), respectively. The odds ratios for a very preterm second delivery among the women who smoked 1 to 9 cigarettes per day and those who smoked 10 or more cigarettes per day, as compared with nonsmokers, were 1.4 (95 percent confidence interval, 1.1 to 1.7) and 1.6 (95 percent confidence interval, 1.3 to 2.0), respectively. The corresponding odds ratios for moderate preterm delivery were 1.3 (95% confidence interval, 1.2 to 1.4) and 1.5 (95 percent confidence interval, 1.4 to 1.6). The women who quit smoking between pregnancies were not at increased risk for very or moderately preterm delivery, whereas the women who started to smoke in the second pregnancy had the same risk as those who continued to smoke. The risk of a very preterm delivery in successive pregnancies is increased primarily among women with a previous very preterm delivery. Changes in smoking habits influence the risk of preterm delivery as well.

Outcome of intrauterine pregnancies with intrauterine device in place and effects of device location on prognosis

Anomalies de fermeture de la paroi abdominale: Prise en charge post-opératoire néonatale et devenir à court terme

Delivery outcomes in a cohort of pregnant patients with COVID-19 with and without viral pneumonia

To examine the gestational weight gain (GWG) trajectory and its possible association with pregnancy outcomes. GWG trajectories were identified using the latent class growth model. Binary logistic regression was performed to examine the associations between adverse pregnancy outcomes and these trajectories. Negeri Sembilan, Malaysia. Two thousand one hundred ninety-three pregnant women. Three GWG trajectories were identified: 'Group 1 - slow initial GWG but followed by drastic GWG', 'Group 2 - maintaining rate of GWG at 0·58 kg/week' and 'Group 3 - maintaining rate of GWG at 0·38 kg/week'. Group 1 had higher risk of postpartum weight retention (PWR) (adjusted OR (AOR) 1·02, 95 % CI 1·01, 1·04), caesarean delivery (AOR 1·03, 95 % CI 1·01, 1·04) and having low birth weight (AOR 1·04, 95 % CI 1·02, 1·05) compared with group 3. Group 2 was at higher risk of PWR (AOR 1·18, 95 % CI 1·16, 1·21), preterm delivery (AOR 1·03, 95 % CI 1·01, 1·05) and caesarean delivery (AOR 1·02, 95 % CI 1·01, 1·03), but at lower risk of having small-for-gestational-age infants (AOR 0·97, 95 % CI 0·96, 0·99) compared with group 3. The significant associations between group 1 and PWR were observed among non-overweight/obese women; between group 1 and caesarean delivery among overweight/obese women; group 2 with preterm delivery and caesarean delivery were only found among overweight/obese women. Higher GWG as well as increasing GWG trajectories was associated with higher risk of adverse pregnancy outcomes. Promoting GWG within the recommended range should be emphasised in antenatal care to prevent the risk of adverse pregnancy outcomes.

Introduction: Our aim was to investigate whether cervical conization and/or loop electrosurgical excision procedure (LEEP) increases the risk of preterm delivery. Materials and Methods: We conducted a retrospective cohort study of singleton deliveries at our institution from 2010 to 2015. Women aged 16-49 years were included in our study. Univariate and logistic regression were used for statistical analyses. An interaction test was used to assess whether maternal human papillomavirus (HPV) positivity within the 3 years before delivery (referred to as maternal HPV status in this study) is an effect modifier. Results: Of 3933 women who delivered at our institution, 19.8% (n = 792) delivered prematurely. Of these women, 9.1% (n = 362) had a history of cervical surgery, including cervical conization and/or LEEP. Notably, a history of cervical surgery was not associated with current HPV status based on the most recent Pap smear results (p > 0.05). In univariate analysis, a history of cervical surgery was associated with preterm delivery (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.26-1.88). This effect was the same among mothers positive (OR = 1.95, 95% CI: 1.16-3.28) and negative (OR = 1.91, 95% CI: 1.10-3.30) for HPV. Pregnancy-induced hypertension, preterm premature rupture of membranes, bacterial vaginosis infection, HPV infection, placenta previa, placental abruption, ethnicity, maternal body mass index, nulliparity, and smoking or drug use were also associated with preterm delivery (p < 0.05). In multivariable analysis, history of cervical surgery remained associated with preterm delivery (OR = 1.75, 95% CI: 1.31-2.33). There was no interaction (p = 0.91) between maternal HPV status and history of cervical conization or LEEP. Discussion and Conclusions: Maternal history of cervical conization and/or LEEP increases the risk of preterm delivery irrespective of concurrent maternal HPV positivity within the 3 years preceding delivery. Maternal HPV status does not modify the effect of history of cervical conization and/or LEEP on preterm delivery.

BackgroundGiven that viral infections can increase the risk of adverse pregnancy outcomes, such as spontaneous miscarriage, preterm premature rupture of membranes, and preterm birth, the effects of COVID-19, a novel emerging coronavirus disease rapidly spreading globally, on pregnancy outcomes have garnered significant attention.MethodsWe conducted a review of studies related to pregnant women infected with SARS-CoV-2 over the past five years (December 2019 to April 2023), utilizing search engines such as PubMed, Web of Science, and the China National Knowledge Infrastructure (CNKI). This study was registered with PROSPERO with ID: CRD42024540849.ResultsA total of 218 articles were screened, with 15 studies meeting the inclusion criteria for this research, including 12 cohort studies, one cross-sectional study, one case-control study, and one case series. Six studies found that the preterm birth rate was higher in the infected group compared to the control group; five studies showed that the cesarean section rate was higher in the infected group; three studies found that the APGAR scores of newborns were higher in the control group than in the infected group; three studies indicated that the mortality rate of newborns in the infected group was higher than that in the control group.ConclusionsOur retrospective review suggests that compared to pregnant women not infected with SARS-CoV-2, those diagnosed with COVID-19 are more likely to experience adverse outcomes such as preterm birth, cesarean delivery, and low birth weight in newborns.

Maternal obesity increases the risk of preterm delivery. Obesity is known to be associated with altered lipid metabolism. To investigate the associations between high maternal triglyceride (mTG) levels during early pregnancy and risks of preterm delivery stratified by early pregnancy body mass index (BMI). Retrospective cohort study. University-based maternity center. 49,612 women with singleton pregnancy who underwent fasting serum lipid screening during early pregnancy. Risk of preterm delivery (total, <37 weeks; early, 28 to 33 weeks; and late, 34 to 36 weeks). Among women enrolled, 2494 had a preterm delivery, including 438 early preterm and 2056 late preterm delivery. High mTG (>90th percentile, 2.04 mM) was associated with shortened gestation. Risks of total, early, and late preterm deliveries increased with mTG levels, and the high mTG-related risk was highest for early preterm delivery [adjusted odds ratio (AOR) 1.72; 95% CI, 1.30 to 2.29]. After stratification by BMI, high mTG was associated with risk of preterm delivery in both overweight or obese (OWO) women (AOR 1.32; 95% CI, 1.02 to 1.70) and women with normal BMI (AOR 1.36; 95% CI, 1.16 to 1.59). In additional sensitivity analyses, we found that high mTG was related to higher risks of preterm delivery among OWO women and women with normal BMI (AOR, 1.54; 95% CI, 1.07 to 2.22 and 1.62, 1.34 to 1.96, respectively), especially early preterm delivery (AOR 2.47; 95% CI, 1.19 to 5.10, and AOR 2.50; 95% CI, 1.65 to 3.78, respectively). High mTG level during early pregnancy increased the risks of preterm delivery not only in OWO women but also in women with normal BMI.

Effective treatment of cervical intraepithelial neoplasia (CIN) can prevent invasive cervical cancer. The trend away from cold-knife conization toward more conservative procedures continues, but it is possible that excisional or ablative treatments might increase the risk of preterm delivery by lessening the mechanical support lent by a shortened cervix. These procedures also could impair local immunity by destroying glandular epithelium, and they might alter the bacterial flora in the cervicovaginal region. This retrospective cohort study, carried out at a colposcopy clinic in Auckland, New Zealand in the years 1988-2000, compared delivery outcomes in 652 women treated for CIN by laser conization, laser ablation, or a loop electrosurgical excision procedure (LEEP) and 426 untreated women. All participants carried a singleton pregnancy to at least 20 completed weeks of gestation. The overall rate of preterm delivery (before 37 weeks gestation) was 13.8%. The most common cause, identified in 45% of cases, was premature rupture of membranes (pPROM). Rates of total pretrerm deliveries, pPROM, and spontaneous preterm labor were higher in treated than in untreated women. Preterm delivery was iatrogenic in 2.9% of the treated group and 5.2% of the untreated group. Adjusted relative risk (aRR) figures showed that treating CIN was not associated with an increased risk of total or spontaneous preterm deliveries, but a single laser conization treatment or LEEP was associated with an increased risk of pPROM leading to preterm delivery. The risk of pPROM increased with an increasing height of excised cervical tissue. Women with a vertical cone height of at least 1.7 cm of tissue removed had a greater than 3-fold increase in risk of preterm delivery compared with untreated women (aRR, 3.6). The risk of pPROM increased linearly with increasing cone height; no threshold value was identified. The risk of all preterm deliveries increased significantly with increasing cone height. Treatment variables did not interact significantly with age, parity, or smoking during pregnancy, Mode of treatment did not relate to cone height. Women who are aware of the risk of preterm delivery associated with treating CIN will be likelier to present at an early stage for antibiotic and steroid treatment. Cervical cerclage might have a role in managing women whose ultrasound studies show progressive cervical shortening during pregnancy.

Salivary proteinase activity: A potential biomarker for preterm premature rupture of the membranes

To evaluate the risk factors for development of neonatal morbidity in cases of preterm premature rupture of membranes (PPROM). The study population consisted of 2326 singleton preterm births occurring between 1994 and 1997 at Soroka University Medical Center. The neonatal morbidity included respiratory distress syndrome, intraventricular hemorrhage (grade III-IV), necrotizing enterocolitis, periventricular leukomalacia, bronchopulmonary dysplasia, neonatal pneumonia and sepsis. A cross-sectional study was designed to compare neonatal morbidity between two groups: the study group consisted of patients with PPROM (n = 376) and the comparison group of patients without PPROM (n = 1950). The prevalence of the neonatal morbidity associated with PPROM was 13.0% (49/376). There was no statistically significant difference in neonatal morbidity rates between the PPROM group and the group with intact membranes in any of the birth-weight groups (Mantel-Haenszel weighted odds ratio 1.20; 95% CI 0.80-1.20), or gestational-age groups (Mantel-Haenszel weighted odds ratio 1.03; 95% CI 0.79-1.55). There was no statistically significant difference in neonatal morbidity between patients with PPROM and those with intact membranes according to clinical chorioamnionitis. Congenital anomalies did not influence the neonatal morbidity when comparing patients with and without PPROM (44.4% vs. 32.8%, respectively; p = 0.23). PPROM was not an independent risk factor for neonatal morbidity in preterm births. Neonatal morbidity was affected mainly by prematurity itself, rather than by the occurrence of PPROM.