The Effect Of Cervical Conization On The Outcome Of Subsequent Fertility And Pregnancy

Objective:To evaluate the effect of conization for cervical intraepithelial neoplasia and carcinoma in situ of cervix on the outcome of subsequent fertility and pregnancy.Materials and Methods:A retrospective study was performed of patients who underwent conization from Oct.1998 to Sep.2008 in Women's Hospital, School of Medicine. Zhejiang University. Those patients below 40-year-old without preoperative infertility, having birth desire and lifting contraception more than] year were followed-up by telephone. At last 62 cases were included as an observation group, and]00 healthy women without history of cervical conization for preconception counseling in our hospital over the same period were collected by randomly chosen as control group. Conization range, time interval from the conization to pregnancy and the outcome of pregnancy in the two groups were retrospectively analyzed. Statistical Methods:Statistical analysis was using statistical software SPSS 16.0. T-test was used to compare measurement data.χ2-test was used to compare enumeration data. The differences were considered to be significant with a P-value of<0.05. Results:(1) general and pregnancy information:There was no significant difference in general information between the two groups. Fifty women with 51 pregnancies were identified among the 62 patients in observation group, and the pregnancy rate was 82.3%(51/62). Eighty-nine women with 91 pregnancies were identified among the 100 patients in control group-and the pregnancy rate was 91.0%(91/100).So the pregnancy rate was not significantly different between the two groups. (2) The outcome of pregnancy:a. There were 5 cases of spontaneous abortion and 45 cases of having given birth in observation group. Seven cases of premature delivery, twelve cases of premature rupture of membranes, five cases of small for gestational age children, and thirty-six cases of cesarean section in the having given birth cases. There were 6 cases of spontaneous abortion and 83 cases of having given birth in control group. In the latter, there were 6 cases of premature labor,8 cases of premature rupture of membranes,3 cases of small for gestational age children and 39 cases of cesarean section. So the premature rupture of membranes and cesarean section rate were significantly different (P< 0.05) between the two groups. But the abortion rate, the incidence of preterm delivery and small for gestational age children wren no significant difference (P > 0.05). b. The observation group was divided by the scope of conization into the "large conization" group and the "small conization" group. The incidence of preterm. premature rupture of membranes, and small for gestational age children in the "large conization" group was higher than that in the "small conization" group, but the difference was not statistically significant. c. The observation group was divided by the time interval between the cervical conization and the initial pregnancy after therapy into three groups such as the "less than 6 months",'"more than or equal to 6 months but less than 12 months" group and "more than or equal to 12 months" group. The preterm birth rate, premature rupture of membranes rate, incidence of small for gestational age children and cesarean section rate were no significant differences among the three groups. d. The observation group was divided by the surgical mode into the LEEP group and the CKC group, and the infertility rate after conization, the incidence of miscarriage, premature labor, premature rupture of membranes, small for gestational age children and cesarean section rate were no significant differences (P> 0.05). Conclusion:Cervical conization didn't significantly effect patients'fertility, and might increased the incidence of premature rupture of membranes and cesarean section, but didn't increase the preterm rate and the incidence of small for gestational age children. The time interval between the cervical conization and the initial pregnancy after therapy and adverse perinatal outcome were no significant correlation. CKC didn't increase the risk of pregnancy after cervical conization compared with LEEP.