Obstetric Outcomes After Conisation Treatment For Cervical Intraepithelial Neoplasia: A Meta Analysis

Background:Generally,the treatment of cervical intraepithelial neoplasia(CIN) is mainlyabout conservative treatment such as cold knife conisation(CKC),loopelectrosurgical excisional procedure(LEEP) and laser conisation(LC), the expandedcervical resection and the complete hysterectomy. Nowadays as patients with CINbecome younger, the conservative treatment to retain women’s reproductivefunction is of great significance. Now more people pay attention to the pregnancyoutcome after conisation treatment of CIN. This Meta analysis focuses on the effectof CKC and LEEP on subsequent fertility and pregnancy outcome.Objective:To evaluate the effect of CKC and LEEP on subsequent fertility and pregnancyoutcome.Materials and Methods:1.search strategy: we searched the computer database of PUBMED、MEDLINE、China National Knowledge Infrastructure and Wan fang database published the fulltext of literature.2.Inclusion criteria:(l)case-contorl trials or retrospective cohort studies of full text ofliterature;(2)studies that can extract the full raw material;(3)the case group with CIN procedured CKC or LEEP, and supplied pregnanciesafter treatment（infertility rate and abortion rate, premature rupture of membranes,preterm labor, cesarean delivery, precipitate labour, cervical laceration, lowweight and perinatal newborn death, etc）(4)the control group without any cervical treatment, cervical appearances andTCT tests are both normal,provided with related matching factors (age, gestationalage, produce inferior).3.Exclusion criteria: (1)studies that have no control group or within the control group there aresomebodies who had cerical treatment or had the cervical cerclage preventionmeasures during pregnancy.(2)studies that contain women who had obvious adverse pregnancy previously,such as patients with recurrent miscarriage or still birth.(3)The case group contains varieties of the cervical treatments, but couldn’tprovide the original data of the pregnancy outcome soly.(4)The case group contains patients who had cervical treatment duringpregnancy.3.Data analysis and statistical methods: We analysed data with Revman5.3statistical software. Heterogeneity among studies were calculated after weightRisk ratio(OR)and95%CIs. If p>0.05, we select fixed effects model throughcalculation and analysis, If P <0.05, we use the random effects model. I2statisticreflects the heterogeneity of the effect of proportion of the total variation.Whenthe I2=0, it indicates that heterogeneity is not observed. In the Cochrane systemevaluation, when I2is≤50%, its heterogeneity can be accepted[1].Results:1.This study included26case control studies and11retrospective cohortstudies including two paired research themselves.2.The study include:15research discussed the CKC and the control group inpregnancy outcomes after surgery，16research discussed the LEEP and the controlgroup in the pregnancy outcome，4research discussed the CKC、the LEEP and thecontrol group in pregnancy outcome，2research discussed the CKC and the LEEP inpregnancy outcomes.3.The outcome of Meta analysis: The OR and95%CI of CKC group and control groupin infertility, miscarriage, premature rupture of membranes, preterm labor,cesarean section, cervical laceration, low weight and perinatal newborn deaths are:1.74[1.10,2.73]、1.35[1.00,1.83]、3.54[2.54,4.92]、2.90[2.35,3.58]、2.23[1.72,2.90]、2.00[0.90,4.47]、2.94[2.11,4.09]、1.16[0.72,1.87]；The OR and95%CI of LEEP group and control group in premature rupture of membranes, preterm labor,cesarean delivery, precipitate labour, low weight and perinatal newborn deaths are:1.24[1.05,1.47]、1.77[1.43,2.20]、0.99[0.88,1.12]、1.34[0.68,2.61]、1.50[1.27,1.77]、1.01[0.71,1.45]；The OR and95%CI of CKC groups and LEEP groupof premature rupture of membranes, preterm birth are:1.81[1.12,2.92]、 1.93[1.26,2.95].Conclusion:CKC was highly associated with infertility, premature rupture ofmembranes, preterm labor, cesarean delivery,and low weight.LEEP was highlyassociated with premature rupture of membranes, preterm labor, and low weight;Therisk of premature rupture of membranes and preterm labor of CKC is much higher thanLEEP.