Pregnancy Outcomes Following Cervical Conization or Loop Electrosurgical Excision Procedures

Importance: Conservative excisional measures used to manage cervical dysplasia are often cited as risk factors for preterm labor in subsequent pregnancies. Objective: We performed an evidence-based review of the obstetric complications following excisional procedures for cervical dysplasia in women of reproductive age. Evidence Acquisition: Between 1993 and 2016, there were 7 published meta-analyses of cohort studies that consistently demonstrated an association between excisional cervical procedures and preterm labor. However, controversy remains as to whether the increased risk is due to the cervical amputation or to the risk factors that underlie the dysplasia. Results: Although data suggest an association between excisional procedures and preterm labor, the choice of the control group may either overestimate or underestimate the relative risk. In addition, recent data suggest that depth of excision greater than 10 to 12 mm is associated with increases in risk of preterm birth. Conclusions: Women with cervical dysplasia are at an increased baseline risk of preterm birth, and surgical excision confers additional risk. Pregnant patients with advanced cervical dysplasia or a history of surgical excision should be considered high-risk pregnancies. Target Audience: Obstetricians and gynecologists, family physicians. Learning Objectives: After completing this activity, the learner should be better able to describe the incidence and risk factors for cervical dysplasia, discuss how these risk factors confound studies assessing pregnancy outcomes following excisional treatment, recognize that women with a history of cervical dysplasia likely have an increased baseline risk of preterm birth, and recall the controversy whether excisional treatment further increases this risk.