Materno-fetal Medicine

Archives of Gynecology and Obstetrics

, Volume 283, Issue 4, pp 765-769

Obstetric outcome following cervical conization

  • Sharon ArmarnikAffiliated withDepartment of Obstetrics and Gynecology, Soroka University Medical CenterFaculty of Health Sciences, Ben-Gurion University of the Negev
  • , Eyal SheinerAffiliated withDepartment of Obstetrics and Gynecology, Soroka University Medical CenterFaculty of Health Sciences, Ben-Gurion University of the Negev Email author 
  • , Benjamin PiuraAffiliated withDepartment of Obstetrics and Gynecology, Soroka University Medical CenterFaculty of Health Sciences, Ben-Gurion University of the Negev
  • , Mihai MeirovitzAffiliated withDepartment of Obstetrics and Gynecology, Soroka University Medical CenterFaculty of Health Sciences, Ben-Gurion University of the Negev
  • , Alexander ZlotnikAffiliated withDepartment of Anesthesiology, Soroka University Medical CenterFaculty of Health Sciences, Ben-Gurion University of the Negev
  • , Amalia LevyAffiliated withDepartment of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben-Gurion University of the Negev

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Abstract

Objective

The purpose of the present study was to examine obstetric outcome of patients following conization and specifically the risk for preterm delivery (PTD).

Methods

A population-based study was performed comparing pregnancies in women following conization with those who had not undergone the procedure. Stratified analysis, using a multiple logistic regression model was performed to control for confounders.

Results

Out of 104,670 deliveries, 53 women (0.05%) had undergone conization. Most conizations were performed using loop electrosurgical excision procedure (LEEP). Using multivariable analysis, the following conditions were significantly associated with conization: advanced maternal age, PTD before the 34th week, low birth weight, and cervical incompetence with cerclage. Higher rates of perinatal mortality were noted in pregnancies of women with conization, but after controlling for PTD, the association lost its significance. The risk of PTD <34 weeks was significantly higher than the comparison group (OR 7.73 95% CI 3.77–15.85, p < 0.001). This association remained significant after controlling for confounders, such as cervical incompetence, smoking, maternal age, birth order and year of delivery (OR 2.8 95% CI 1.3–6.1, p = 0.008). When comparing pregnancy outcomes of women with and without cerclage due to cervical incompetence, no significant differences were documented.

Conclusions

A clear association exists between conization and PTD before the 34th week. This association persists after controlling for variables considered to coexist with PTD. Carful surveillance is required in pregnancies of women following conization for early detection of preterm contractions and PTD.

Keywords

Conization Cold knife Loop electrosurgical excision procedure (LEEP) Cerclage Premature rupture of membranes (PROM)