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Laser vaporization of the cervix is associated with an increased risk of preterm birth and rapid labor progression in subsequent pregnancies



Laser vaporization of the cervix is an established method of treating cervical intra-epithelial neoplasia, but its effect on subsequent pregnancies remains controversial. The aim of this study was to investigate pregnancy outcomes after laser vaporization.


We conducted a retrospective study involving women who delivered live singletons between 2012 and 2019 in a tertiary hospital. The risks of adverse pregnancy outcomes after laser vaporization of the cervix were assessed using a multivariate regression model. The primary outcome was the adjusted odds ratio for preterm births. We also evaluated the course of labor progression, duration of labor, risk of emergency cesarean deliveries, and the risk of cervical laceration as secondary outcomes.


In total, 3359 women were analyzed in this study. The risk of preterm birth was significantly higher in pregnancies after laser vaporization of the cervix (adjusted odds ratio [AOR] 1.84, 95% confidence interval [95% CI] 1.06–3.20; p = 0.030). The duration of the first stage of labor was significantly shorter in the post-treatment group (median 255 min vs. 355 min; p = 0.0049). We did not observe significant differences in the duration of the second stage of labor (median 21 min vs 20 min; p = 0.507) or the rates of other obstetric events, including emergency cesarean deliveries (AOR 0.736; 95% CI 0.36–1.50; p = 0.400) and cervical laceration (AOR 0.717; 95% CI 0.22–2.35; p = 0.582).


Laser vaporization of the cervix is associated with an increased risk of preterm births and a shorter duration of the first stage of labor in subsequent pregnancies. Careful consideration is necessary when selecting a method of treatment for the uterine cervix of patients wishing future pregnancies.

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Data availability

The data analyzed in this study is available in the Mendely repository,



Adjusted odds ratio


Body mass index


Cervical intraepithelial neoplasia


Crude odds ratio


Neonatal intensive care unit


  1. 1.

    Cancer Information Service, National Cancer Center, Japan.

  2. 2.

    Ikeda S, Ueda Y, Yagi A et al (2019) HPV vaccination in Japan: what is happening in Japan? Expert Rev Vaccin 18:323–325

    CAS  Article  Google Scholar 

  3. 3.

    Baggish MS (1986) A comparison between laser excisional conization and laser vaporization for the treatment of cervical intraepithelial neoplasia. AJOG 155:39–44

    CAS  Article  Google Scholar 

  4. 4.

    Fallani MG, Penna C, Fambrini M, Marchionni M (2003) Laser CO2 vaporization for high-grade cervical intraepithelial neoplasia: a long-term follow-up series. Gynecol Oncol 91:130–133

    Article  Google Scholar 

  5. 5.

    Sasieni P, Castanon A, Landy R, Kyrgiou M, Kitchener H, Quigley M et al (2015) Risk of preterm birth following surgical treatment for cervical disease: executive summary of a recent symposium. BJOG 123:1426–1429

    Article  Google Scholar 

  6. 6.

    Paraskevaidis E, Kyrgiou M, Martin-Hirsch P (2007) Have we dismissed ablative treatment too soon in colposcopy practice? BJOG 114:3–4

    CAS  Article  Google Scholar 

  7. 7.

    Bruinsma FJ, Quinn MA (2011) The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis. BJOG 118:1031–1041

    CAS  Article  Google Scholar 

  8. 8.

    Sadler L, Saftlas A, Wang W, Exeter M, Whittaker J, McCowan L (2004) Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA 291:2100–2106

    CAS  Article  Google Scholar 

  9. 9.

    Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E (2006) Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet 367:489–498

    CAS  Article  Google Scholar 

  10. 10.

    Arbyn M, Kyrgiou M, Simoens C et al (2008) Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ 337:a1284–a1294

    CAS  Article  Google Scholar 

  11. 11.

    Jakobsson M, Gissler M, Sainio S, Paavonen J, Tapper AM (2007) Preterm delivery after surgical treatment for cervical intraepithelial neoplasia. Obstet Gynecol 109:309–313

    Article  Google Scholar 

  12. 12.

    Kyrgiou M, Athanasiou A, Paraskevaidi M et al (2016) Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. BMJ 354:i3633

    Article  Google Scholar 

  13. 13.

    Kyrgiou M, Athanasiou A, Kalliala IEJ et al (2017) Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease. Cochrane Database Syst Rev 272:109–241

    Google Scholar 

  14. 14.

    Melamed N (2009) Intrapartum cervical lacerations: characteristics, risk factors, and effects on subsequent pregnancies. Am J Obstet Gynecol 200(4):388.e1–4

    Article  Google Scholar 

  15. 15.

    Wong LF, Wilkes J, Korgenski K, Varner MW, Manuck TA (2016) Intrapartum cervical laceration and subsequent pregnancy outcomes. AJP Rep 6:e318–e323

    Article  Google Scholar 

  16. 16.

    Noehr B, Jensen A, Frederiksen K, Tabor A, Kjaer SK (2009) Depth of cervical cone removed by loop electrosurgical excision procedure and subsequent risk of spontaneous preterm delivery. Obstet Gynecol 114:1232–1238

    Article  Google Scholar 

  17. 17.

    Himes KP, Simhan HN (2007) Time from cervical conization to pregnancy and preterm birth. Obstet Gynecol 109:314–319

    Article  Google Scholar 

  18. 18.

    Weinmann S, Naleway A, Swamy G et al (2017) Pregnancy outcomes after treatment for cervical cancer precursor lesions: an observational study. PLoS ONE 12:e0165276-e165314

    Article  Google Scholar 

  19. 19.

    Jauniaux E, Alfirevic Z, Bhide AG et al (2018) Placenta praevia and placenta accreta: diagnosis and management. BJOG 126:e1–e48

    Article  Google Scholar 

  20. 20.

    Goldenberg RL, Culhane JF, Iams JD, Romero R (2008) Epidemiology and causes of preterm birth. Lancet 371:75–84

    Article  Google Scholar 

  21. 21.

    Shiozaki A, Yoneda S, Nakabayashi M et al (2014) Multiple pregnancy, short cervix, part-time worker, steroid use, low educational level and male fetus are risk factors for preterm birth in Japan: a multicenter, prospective study. J Obstet Gynaecol Res 40:53–61

    Article  Google Scholar 

  22. 22.

    Nitahara K, Fujita Y, Magarifuchi N, Taniguchi S, Shimamoto T (2021) Maternal characteristics and neonatal outcomes of emergency repeat caesarean deliveries due to early-term spontaneous labour onset. Aust N Z J Obstet Gynaecol 61:48–54

    Article  PubMed  Google Scholar 

  23. 23.

    Sadler L, Saftlas A (2007) Cervical surgery and preterm birth. J Perinat Med 35:5–9

    Article  Google Scholar 

  24. 24.

    Bevis KS, Biggio JR (2011) Cervical conization and the risk of preterm delivery. Am J Obstet Gynecol 205:19–27

    Article  Google Scholar 

  25. 25.

    Guglielminotti J, Landau R, Li G (2019) Adverse events and factors associated with potentially avoidable use of general anesthesia in cesarean deliveries. Anesthesiology 130:912–922

    Article  Google Scholar 

  26. 26.

    Nitahara K, Hidaka N, Sakai A, Kido S, Kato K (2020) The impact of general anesthesia on mother-infant bonding for puerperants who undergo emergency cesarean deliveries. Cervical conization and the risk of preterm delivery. J Perinat Med. 48:463–470

    Article  Google Scholar 

  27. 27.

    Yoon BS, Seong SJ, Song T, Kim M-L, Kim MK (2014) Risk factors for treatment failure of CO2 laser vaporization in cervical intraepithelial neoplasia 2. Arch Gynecol Obstet 290:115–119

    CAS  Article  Google Scholar 

  28. 28.

    Sharp GL, Cordiner JW, Murray EL, More IA (1984) Healing of cervical epithelium after laser ablation of cervical intraepithelial neoplasia. J Clin Pathol 37:611–615

    CAS  Article  Google Scholar 

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Author information




KN: Project development, data analysis, manuscript writing. YF: Manuscript editing. DT, NM and ST: data collection. TS: Data collection, data management. All authors approved the final manuscript.

Corresponding author

Correspondence to Kenta Nitahara.

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There is no conflict of interest to be declared.

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This retrospective study was performed after obtaining approval from the institutional ethics committee of Miyazaki Prefectural Miyazaki Hospital (Approval number: 19-58). Because of the retrospective nature of the study and the anonymization of the collected data, patient consent was waivered by the committee.

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Nitahara, K., Fujita, Y., Tanaka, D. et al. Laser vaporization of the cervix is associated with an increased risk of preterm birth and rapid labor progression in subsequent pregnancies. Arch Gynecol Obstet 304, 895–902 (2021).

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  • Laser vaporization of the cervix
  • Cervical conization
  • Cervical intraepithelial neoplasia
  • Preterm births
  • Labor progression