Journal
BEST PRACTICE & RESEARCH CLINICAL OBSTETRICS & GYNAECOLOGY
Volume 75, Issue -, Pages 10-22Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.bpobgyn.2021.05.007
Keywords
Local excision; LLETZ; Cone biopsy; Cervical cancer; CIN; HPV
Categories
Funding
- National Institute for Health Research (NIHR) [PB-PG-0816-20004]
- Genesis Research Trust
- Imperial Health Charity predoctoral fellowship [P73337]
- Wellcome Trust Imperial 4i/NIHR BRC clinical PhD fellowship [P77712]
- National Institutes of Health Research (NIHR) [PB-PG-0816-20004] Funding Source: National Institutes of Health Research (NIHR)
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Treating CIN may increase the risk of preterm birth, caution is needed when making treatment decisions. Treatment should be conducted effectively to optimize disease clearance and minimize recurrence risk.
The awareness that cervical intra-epithelial neoplasia (CIN) treatment increases the risk of preterm birth has led to major changes in clinical practice. Women with CIN have a higher baseline risk of prematurity but local treatment further increases this risk. The risk further increases with increasing cone length and multiplies for repeat excisions; it is unclear whether small cones confer any additional risk to CIN alone. There is no evidence to suggest that fertility is affected by local treatment, although this increases the risk of mid-trimester loss. Caution should prevail when deciding to treat women with CIN of reproductive age. If treatment is offered, this should be conducted effectively to optimise the clearance of disease and minimise the risk of recurrence. Colposcopists should alert women undergoing treatment that this may increase the risk of preterm birth and that they may be offered interventions when pregnant. The cone length should be clearly documented and used as a risk stratifier. (c) 2021 Published by Elsevier Ltd.
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