Delaying conception urged after cervical conization

OB/GYN News, May 15, 2006 by Kate Johnson

TORONTO -- Women who undergo cervical conization for the treatment of cervical intraepithelial neoplasia may benefit from delaying conception for about a year to reduce their risk of preterm birth, Dr. Katherine P. Himes said at the annual meeting of the Society for Gynecologic Investigation.

Moreover, African American women may need to delay conception even longer, although the ideal time interval is not clear, Dr. Himes said.

"Cones are common, and most women do fine--which is why when you look overall you tend not to find obstetrical risks associated with the procedure," she said in an interview.

"This study may identify a population where significant risk exists, so this may hopefully help us in terms of our counseling and surveillance."

In the retrospective study she presented, Dr. Himes of the department of obstetrics and gynecology, Magee-Women's Hospital, Pittsburgh, identified 1,080 women who had become pregnant after undergoing a colposcopic biopsy, a loop electrosurgical excision procedure, or a cold-knife cone biopsy. Overall, cervical conization was not associated with an increased rate of preterm birth, which occurred in 12.7% of the cohort.

However, when the time from conization to conception was analyzed, women who experienced preterm birth had a significantly shorter mean interval of 3.5 months, compared with women who did not have preterm birth, who had an mean interval of 11 months.

This difference remained statistically significant even after controlling for the confounders of race, tobacco use, prior preterm birth, and cone dimensions, she said.

The risk was found to be more persistent among African American women, compared with white women.

"African American women remain at increased risk of preterm birth longer than [whites] after undergoing conization and so it may be advisable for them to wait even longer--although how long is unclear," Dr. Himes said.

BY KATE JOHNSON

Montreal Bureau