子宮頸円錐切除術と早産および帝王切開の将来リスク

Cervical cancer stands as the fourth most prevalent malignancy affecting women on a global scale, with its origin predominantly linked to the presence of human papillomavirus (HPV), causing cervical intraepithelial lesions. When high-grade lesions are recognized, it often necessitates an excisional procedure (cervical conization). In women of childbearing age, the impact of conization on pregnancy outcomes remains an area of conflicting evidence. In this study, we compare pregnancy outcomes among women who underwent cervical conization and investigate whether cervical conization heightens the risk of adverse pregnancy outcomes and specifically, the risk for preterm delivery and cesarean delivery.

This is a retrospective cohort study of women who had undergone cervical conization and had at least one subsequent pregnancy and delivery at the Soroka University Medical Center (SUMC). First, this group of women was compared with a matched cohort (by demographic characteristics such as age, parity and ethnicity with a 4:1 ratio) of women without a history of cervical conization in order to examine pregnancy complications and perinatal outcomes. Later, pregnancy outcomes were compared only among women with cervical conization based on pre- and post-conization characteristics, such as pre-conization PAP results and biopsy results after colposcopy, and post-conization cone size (largest diameter), cervical histology results and endocervical glands involvement.

A total of 78 women who had cervical conization and at least one subsequent pregnancy and delivery were included in the analysis and were later compared with a matched cohort of 312 women without cervical conization. When compared to a matched cohort of women without a cervical conization, women with a cervical conization had an increased risk for preterm premature rupture of membranes (p<0.001) and preterm delivery (p=0.02). Rates of cesarean delivery were significantly higher in women with cervical conization, however, the risk for cesarean section was not increased due to the conization procedure itself. In the study group, we found no significant differences in pregnancy complications or perinatal outcomes between women with cervical conization based on pre- or post-conization characteristics.

Cervical conization procedure was found to be a significant risk factor for preterm premature rupture of membranes and preterm delivery in subsequent pregnancies.