J Gynecol Oncol.  2010 Dec;21(4):230-236. 10.3802/jgo.2010.21.4.230.

The role of prophylactic cerclage in preventing preterm delivery after electrosurgical conization

• Shin MY
• Seo ES
• Choi SJ
• Oh SY
• Kim BG
• Bae DS
• Kim JH
• Roh CR

• KMID: 2173546
• DOI: http://doi.org/10.3802/jgo.2010.21.4.230

Abstract

OBJECTIVE
To evaluate pregnancy outcomes after electrosurgical conization.
METHODS
We retrospectively analyzed the outcomes of 56 singleton pregnancies after electrosurgical conization of the uterine cervix. Of the 56 cases, 25 women underwent prophylactic cerclage with McDonald procedure (cerclage group), and 31 were managed expectantly (expectant group). Pregnancy outcomes including rate of preterm delivery were compared, and the effect of potential risk factors such as depth of cone, interval between conization and pregnancy, and cervical length on the risk of preterm delivery was assessed.
RESULTS
The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization than those without (32.1% vs. 15.2%, p<0.001). However, preterm delivery rate was not different between the two groups (expectant group vs. cerclage group; <28 week, 6.5% vs. 8.0%, p=1.000; <34 week, 19.4% vs. 20.0%, p=1.000; <37 week, 29.0% vs. 36.0%, p=0.579). All obstetric and neonatal outcomes were similar in the two groups. Even when we confined the study subjects to 19 women (19/56, 33.9%) with cervical length less than 25 mm, the preterm delivery rate also was not significantly different between the expectant (n=7) and cerclage group (n=12). Finally, the potential risk factors for preterm delivery were not associated with risk of preterm delivery in patients with a history of electrosurgical conization.
CONCLUSION
The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization before pregnancy. However, prophylactic cervical cerclage did not prevent preterm delivery in these patients.

Keyword

Conization; Preterm birth; Cervical cerclage

MeSH Terms

Cerclage, Cervical
Cervix Uteri
Conization
Female
Humans
Pregnancy
Pregnancy Outcome
Premature Birth
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 An abdominopelvic magnetic resonance imaging (MRI) taken after conization for early cervical cancer stage IA1. There is no demonstrable cervical cancer on the current MRI view. Note the large defect in the cervix as a cone shape after electrosurgical conization procedure (arrow).

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