Human Reproduction Archives
Human Reproduction Archives
Review Article Fetal Medicine

Risk of preterm delivery in gestations following the treatment of Cervical Intraepithelial Neoplasia (CIN) according to cone dimensions: systematic review

Beatriz Neves Teixeira, Caroline Teixeira Vieira de Carvalho, Rosane Ribeiro Figueiredo-Alves

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Background: There is evidence of increased risk of adverse events in subsequent pregnancies to CIN treatment. However, it is unclear what risk factors are associated with preterm delivery. Objective: To provide evidence for the association between excised uterine cervix dimensions and preterm delivery. Methodology: Systematic review about the association between the excised dimensions of the cervix and the occurrence of preterm birth in subsequent pregnancies after CIN treatment. The survey was conducted in the PUBMED database from 2004 to 2015, in the English language. It was excluded articles that, although they assessed complications in subsequent pregnancies after CIN treatment, did not evaluate association between cone dimensions and preterm birth occurrence. Results: It was included eight retrospective cohorts, one prospective cohort and one case-control study. The number of participants in ten studies was 8.185. The association between preterm birth and cone depth was evidenced in eight studies and not shown in two. Four studies evaluated the relationship between excised volume and preterm birth, with discordant results. The number of conizations was evaluated in six studies, with results also discordant. Conclusion: It is unclear whether the excised tissue dimensions would be isolated risk factors for preterm delivery.


Cervical Intraepithelial Neoplasia; preterm delivery; conisation; dimensions.


1. ZURHAUSEN H. Papillomavirus in the causation of human cancers: a brief historical account. Virology. 2009;384:260-5.
<br/><br/>2. Instituto Nacional do Câncer. Estimativas de incidência de câncer no Brasil [Internet] 2016 [cited 2017 May 17]. Available from:
<br/><br/>3. MEIJER CJL, WALBOOMERS JMM. Cervical cytologic after 2000: Where to go? J Clin Pathol. 2000;53:41-3.
<br/><br/>4. PATNICK J. Cervical cancer screening in England. Eur J Cancer. 2000;35:2335-9.
<br/><br/>5. MASSAD LS, EINSTEIN MH, HUH WK, KATKI HA, KINNEY WK, SCHIFFMAN M, et al. 2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors. Obstet Gynecol. 2013;121(4):829-46.
<br/><br/>6. InstitutoNacional de Câncer. Diretrizes Brasileiras para o Rastreamento do Câncer do Colo do Útero [Internet]. Rio de Janeiro: Ministério da Saúde; 2016 [cited 2017 May 17]. Available from:
<br/><br/>7. PRENDIVILLE W, CULLIMORE NS. Large loop excision of the transformation zone (LLETZ): a new method of management for women with cervical intraepithelial neoplasia. Br J Obstet Gynaecol. 1989;96:1054-60.
<br/><br/>8. LINDEQUE BG. Management of cervical premalignant lesions. Best Pract Res Clin Obstet Gynaecol. 2005;19:545-61.
<br/><br/>9. KYRGIOU M, KOLIOPOULOS G, MARTIN-HIRSCH P, ARBYN M, PRENDIVILLE W, PARASKEVAIDIS E. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet. 2006;367(9509):489-98.
<br/><br/>10. SAMSON SL, BENTLEY JR, FAHEY TJ, MCKAY DJ, GILL GH. The effect of loop electrosurgical excision procedure on future pregnancy outcome. Obstet Gynecol. 2005;105:325-32.
<br/><br/>11. NOEHR B, JENSEN A, FREDERIKSEN K, TABOR A, KJAER SK. Depth of cervical cone removed by loop electrosurgical excision procedure and subsequent risk of spontaneous preterm delivery. Obstet Gynecol. 2009;114:1232-8.
<br/><br/>12. KHALID S, DIMITRIOU E, CONROY R, PARASKEVAIDIS E, KYRGIOU M, HARRITY C, et al. The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy-related morbidity. BJOG. 2012;119:685-91.
<br/><br/>13. KITSON SJ, GREIG E, MICHAEL E, SMITH M. Predictive value of volume of cervical tissue removed during LLETZ on subsequent preterm delivery: a cohort study. Eur J Obstet Gynecol Reprod Biol. 2014;180:51-5.
<br/><br/>14. KYRGIOU M, VALASOULIS G, STASINOU S-M, FOUNTA C, ATHANASIOU A, BENNETT P, et al. Proportion of cervical excision for cervical intraepithelial neoplasia as a predictor of pregnancy outcomes. Int J Gynaecol Obstet. 2015;128(2):141-7.
<br/><br/>15. LIVERANI CA, DI GIUSEPPE J, CLEMENTE N, CARPINI GD, MONTIA E, FANETTIA F, et al. Length but not transverse diameter of the excision specimen for high-grade cervical intraepithelial neoplasia (CIN 2–3) is a predictor of pregnancy outcome. Eur J Cancer Prev. 2015;25(5):416-22.
<br/><br/>16. SADLER L, SAFTLAS A, WANG W, EXETER M, JOHN WHITTAKER J, MCCOWAN L. Treatment for Cervical Intraepithelial Neoplasia and Risk of Preterm Delivery. JAMA. 2004;291(17):2100-6.
<br/><br/>17. ORTOFT G, HENRIKSEN T, HANSEN E, PETERSEN L. After conisation of the cervix, the perinatal mortality as a result of preterm delivery increases in subsequent pregnancy. BJOG. 2010;117:258-67.
<br/><br/>18. SIMOENS C, GOFFIN F, SIMON P, BARLOW P, ANTOINE J, FOIDART J, et al. Adverse obstetrical outcomes after treatment of precancerous cervical lesions: a Belgian multicentre study. BJOG. 2012;119:1247-55.
<br/><br/>19. CASTANON A, LANDY R, BROCKLEHURST P, EVANS H, PEEBLES D, SINGH N, et al. PaCT Study Group. Risk of preterm delivery with increasing depth of excision for cervical intraepithelial neoplasia in England: nested case-control study. BMJ. 2014;349:g6223.
<br/><br/>20. LIMA NL. Estudo sobre o cálculo de áreas e volumes utilizando o Método de Exaustão e o Princípio de Cavalieri [dissertação]. Joao Pessoa: Universidade Federal da Paraíba; 2013.

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