Reproductive Impact of Cervical Conization

Excisional procedures, such as loop electrosurgery (LEEP) and cold knife conization, are recommended treatments for cervical intraepithelial dysplasia (CIN). CIN and excisional treatments are associated with an increased risk of preterm delivery and premature rupture of membranes. This association is fairly consistent across studies focusing on cold knife conization, procedures removing deeper tissue specimens, and repeat procedures. Because the association is not as strong or consistent for single, shallow LEEPs, it is possible that the increased risk may be related, at least partly, to other factors (confounding). To prevent complications, treatment guidelines should be strictly followed to minimize overtreatment. General measures to prevent preterm birth, such as screening and treating infections and smoking cessation should be considered. Given the lack of evidence on the impact of progesterone to prevent preterm delivery in this population, further studies will be needed to determine if transvaginal sonographic cervical length measurement should be offered routinely during pregnancy.