Top

Archives of Gynecology and Obstetrics

Published in:

01-10-2021 | Premature Birth | Maternal-Fetal Medicine

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

Authors: Kenta Nitahara, Yasuyuki Fujita, Daichi Tanaka, Naomi Magarifuchi, Shuichi Taniguchi, Tomihiro Shimamoto

Published in: Archives of Gynecology and Obstetrics | Issue 4/2021

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

Cancer Information Service, National Cancer Center, Japan. http://ganjoho.jp/reg_stat/index.html

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

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

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 91:130–133CrossRef

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 123:1426–1429CrossRef

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

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 118:1031–1041CrossRef

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

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 367:489–498CrossRef

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–a1294CrossRef

11.

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

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:i3633CrossRef

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

14.

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

15.

Wong LF, Wilkes J, Korgenski K, Varner MW, Manuck TA (2016) Intrapartum cervical laceration and subsequent pregnancy outcomes. AJP Rep 6:e318–e323CrossRef

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 114:1232–1238CrossRef

17.

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

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-e165314CrossRef

19.

Jauniaux E, Alfirevic Z, Bhide AG et al (2018) Placenta praevia and placenta accreta: diagnosis and management. BJOG 126:e1–e48CrossRef

20.

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

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 40:53–61CrossRef

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 61:48–54CrossRefPubMed

23.

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

24.

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

25.

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

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. 48:463–470CrossRef

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 290:115–119CrossRef

28.

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

Title: Laser vaporization of the cervix is associated with an increased risk of preterm birth and rapid labor progression in subsequent pregnancies
Authors: Kenta Nitahara
Yasuyuki Fujita
Daichi Tanaka
Naomi Magarifuchi
Shuichi Taniguchi
Tomihiro Shimamoto
Publication date: 01-10-2021
Publisher: Springer Berlin Heidelberg
Keywords: Premature Birth
Conisation
Laser
Published in: Archives of Gynecology and Obstetrics / Issue 4/2021
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-021-06025-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2021

Black and white vulvar lesions: reticulate genital melanosis and vitiligo

Evaluation of the sexual quality of life and sexual function of cervical cancer survivors after cancer treatment: a retrospective trial

Long non-coding RNA MALAT1 regulates trophoblast functions through VEGF/VEGFR1 signaling pathway

Alpha-fetoprotein (AFP)-producing epithelial ovarian carcinoma (EOC): a retrospective study of 27 cases

Retraction Note: Vaginal progesterone for prevention of preterm labor in asymptomatic twin pregnancies with sonographic short cervix: a randomized clinical trial of efficacy and safety

Detection of hysteroscopic fluid in the pouch of Douglas: a prospective cohort study about the predictability of bilateral tubal occlusion