Risk of preterm birth after the excisional surgery for cervical lesions

a propensity-score matching study in Japan

Kei Miyakoshi, Atsuo Itakura, Takayuki Abe, Eiji Kondoh, Yasuhisa Terao, Tsutomu Tabata, Hiromi Hamada, Kyoko Tanaka, Mamoru Tanaka, Naohiro Kanayama, Satoru Takeda

Research output: Contribution to journalArticle

Abstract

Introduction: There is a paucity of data on the risk of preterm birth subcategorized by gestational age in pregnancies after the pre-pregnancy excisional treatment for cervical lesions. In addition, little is known about the effect of prophylactic cerclage on the risk of preterm birth. The aim of this study was to investigate the risk of preterm birth stratified by gestational period and its reduction by the prophylactic cerclage in women with prior excisional surgery. Materials and methods: We retrospectively analyzed a cohort of singleton pregnancies in the Japan Perinatal Registry Network Database (2013–2014, n = 307,001). Cases included pregnancies after the surgery (i.e. conization and loop electrosurgical excision procedure). Controls comprised the propensity-score matched pregnancies without pre-pregnancy surgery. The main outcome was the occurrence of preterm birth. The effect of prophylactic cervical cerclage on the risk of preterm birth after the excisional surgery was also examined using cases. Results: In the propensity-score matched population (cases, n = 1389; controls, n = 1389), cases exhibited a higher risk of preterm birth and preterm prelabor rupture of membranes (PROM), compared with controls (preterm birth: 25.3 versus 10.6%; preterm PROM: 14.0 versus 3.5%: both p <.0001). Odds ratios (OR; 95% confidence interval [CI]) for preterm birth at 22–27 weeks, 28–31 weeks, 32–33 weeks, and 34–36 weeks were 3.4 [1.8–6.5], 4.6 [2.7–7.7], 2.2 [1.4–3.5], and 2.1 [1.6–2.7], respectively. The association was stronger for preterm PROM at earlier gestational age (22–27 weeks, 28–31 weeks, 32–33 weeks, and 34–36 weeks: 5.2 [2.3–11.8], 7.1 [3.4–15.0], 3.8 [1.7–8.3], and 3.9 [1.8–4.6], respectively). In cases, 171 underwent the prophylactic cervical cerclage. The occurrence of preterm birth and preterm PROM was comparable between those with and without the cerclage (28.7 versus 24.2, and 12.9 versus 13.3%, respectively). Conclusions: Pre-pregnancy excisional cervical surgery was associated with the increased risk of preterm birth, especially before 32 weeks of gestation. The prophylactic cerclage did not reduce the risk of preterm birth.

Original languageEnglish
JournalJournal of Maternal-Fetal and Neonatal Medicine
DOIs
Publication statusPublished - 2019 Jan 1

Fingerprint

Propensity Score
Premature Birth
Japan
Pregnancy
Rupture
Cervical Cerclage
Membranes
Gestational Age
Conization
Registries
Odds Ratio
Databases
Confidence Intervals

Keywords

  • Cervical cerclage
  • cervical lesions
  • excisional surgery
  • prelabor rupture of membranes
  • preterm birth

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynaecology

Cite this

Risk of preterm birth after the excisional surgery for cervical lesions : a propensity-score matching study in Japan. / Miyakoshi, Kei; Itakura, Atsuo; Abe, Takayuki; Kondoh, Eiji; Terao, Yasuhisa; Tabata, Tsutomu; Hamada, Hiromi; Tanaka, Kyoko; Tanaka, Mamoru; Kanayama, Naohiro; Takeda, Satoru.

In: Journal of Maternal-Fetal and Neonatal Medicine, 01.01.2019.

Research output: Contribution to journalArticle

Miyakoshi, Kei ; Itakura, Atsuo ; Abe, Takayuki ; Kondoh, Eiji ; Terao, Yasuhisa ; Tabata, Tsutomu ; Hamada, Hiromi ; Tanaka, Kyoko ; Tanaka, Mamoru ; Kanayama, Naohiro ; Takeda, Satoru. / Risk of preterm birth after the excisional surgery for cervical lesions : a propensity-score matching study in Japan. In: Journal of Maternal-Fetal and Neonatal Medicine. 2019.
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title = "Risk of preterm birth after the excisional surgery for cervical lesions: a propensity-score matching study in Japan",
abstract = "Introduction: There is a paucity of data on the risk of preterm birth subcategorized by gestational age in pregnancies after the pre-pregnancy excisional treatment for cervical lesions. In addition, little is known about the effect of prophylactic cerclage on the risk of preterm birth. The aim of this study was to investigate the risk of preterm birth stratified by gestational period and its reduction by the prophylactic cerclage in women with prior excisional surgery. Materials and methods: We retrospectively analyzed a cohort of singleton pregnancies in the Japan Perinatal Registry Network Database (2013–2014, n = 307,001). Cases included pregnancies after the surgery (i.e. conization and loop electrosurgical excision procedure). Controls comprised the propensity-score matched pregnancies without pre-pregnancy surgery. The main outcome was the occurrence of preterm birth. The effect of prophylactic cervical cerclage on the risk of preterm birth after the excisional surgery was also examined using cases. Results: In the propensity-score matched population (cases, n = 1389; controls, n = 1389), cases exhibited a higher risk of preterm birth and preterm prelabor rupture of membranes (PROM), compared with controls (preterm birth: 25.3 versus 10.6{\%}; preterm PROM: 14.0 versus 3.5{\%}: both p <.0001). Odds ratios (OR; 95{\%} confidence interval [CI]) for preterm birth at 22–27 weeks, 28–31 weeks, 32–33 weeks, and 34–36 weeks were 3.4 [1.8–6.5], 4.6 [2.7–7.7], 2.2 [1.4–3.5], and 2.1 [1.6–2.7], respectively. The association was stronger for preterm PROM at earlier gestational age (22–27 weeks, 28–31 weeks, 32–33 weeks, and 34–36 weeks: 5.2 [2.3–11.8], 7.1 [3.4–15.0], 3.8 [1.7–8.3], and 3.9 [1.8–4.6], respectively). In cases, 171 underwent the prophylactic cervical cerclage. The occurrence of preterm birth and preterm PROM was comparable between those with and without the cerclage (28.7 versus 24.2, and 12.9 versus 13.3{\%}, respectively). Conclusions: Pre-pregnancy excisional cervical surgery was associated with the increased risk of preterm birth, especially before 32 weeks of gestation. The prophylactic cerclage did not reduce the risk of preterm birth.",
keywords = "Cervical cerclage, cervical lesions, excisional surgery, prelabor rupture of membranes, preterm birth",
author = "Kei Miyakoshi and Atsuo Itakura and Takayuki Abe and Eiji Kondoh and Yasuhisa Terao and Tsutomu Tabata and Hiromi Hamada and Kyoko Tanaka and Mamoru Tanaka and Naohiro Kanayama and Satoru Takeda",
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T1 - Risk of preterm birth after the excisional surgery for cervical lesions

T2 - a propensity-score matching study in Japan

AU - Miyakoshi, Kei

AU - Itakura, Atsuo

AU - Abe, Takayuki

AU - Kondoh, Eiji

AU - Terao, Yasuhisa

AU - Tabata, Tsutomu

AU - Hamada, Hiromi

AU - Tanaka, Kyoko

AU - Tanaka, Mamoru

AU - Kanayama, Naohiro

AU - Takeda, Satoru

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: There is a paucity of data on the risk of preterm birth subcategorized by gestational age in pregnancies after the pre-pregnancy excisional treatment for cervical lesions. In addition, little is known about the effect of prophylactic cerclage on the risk of preterm birth. The aim of this study was to investigate the risk of preterm birth stratified by gestational period and its reduction by the prophylactic cerclage in women with prior excisional surgery. Materials and methods: We retrospectively analyzed a cohort of singleton pregnancies in the Japan Perinatal Registry Network Database (2013–2014, n = 307,001). Cases included pregnancies after the surgery (i.e. conization and loop electrosurgical excision procedure). Controls comprised the propensity-score matched pregnancies without pre-pregnancy surgery. The main outcome was the occurrence of preterm birth. The effect of prophylactic cervical cerclage on the risk of preterm birth after the excisional surgery was also examined using cases. Results: In the propensity-score matched population (cases, n = 1389; controls, n = 1389), cases exhibited a higher risk of preterm birth and preterm prelabor rupture of membranes (PROM), compared with controls (preterm birth: 25.3 versus 10.6%; preterm PROM: 14.0 versus 3.5%: both p <.0001). Odds ratios (OR; 95% confidence interval [CI]) for preterm birth at 22–27 weeks, 28–31 weeks, 32–33 weeks, and 34–36 weeks were 3.4 [1.8–6.5], 4.6 [2.7–7.7], 2.2 [1.4–3.5], and 2.1 [1.6–2.7], respectively. The association was stronger for preterm PROM at earlier gestational age (22–27 weeks, 28–31 weeks, 32–33 weeks, and 34–36 weeks: 5.2 [2.3–11.8], 7.1 [3.4–15.0], 3.8 [1.7–8.3], and 3.9 [1.8–4.6], respectively). In cases, 171 underwent the prophylactic cervical cerclage. The occurrence of preterm birth and preterm PROM was comparable between those with and without the cerclage (28.7 versus 24.2, and 12.9 versus 13.3%, respectively). Conclusions: Pre-pregnancy excisional cervical surgery was associated with the increased risk of preterm birth, especially before 32 weeks of gestation. The prophylactic cerclage did not reduce the risk of preterm birth.

AB - Introduction: There is a paucity of data on the risk of preterm birth subcategorized by gestational age in pregnancies after the pre-pregnancy excisional treatment for cervical lesions. In addition, little is known about the effect of prophylactic cerclage on the risk of preterm birth. The aim of this study was to investigate the risk of preterm birth stratified by gestational period and its reduction by the prophylactic cerclage in women with prior excisional surgery. Materials and methods: We retrospectively analyzed a cohort of singleton pregnancies in the Japan Perinatal Registry Network Database (2013–2014, n = 307,001). Cases included pregnancies after the surgery (i.e. conization and loop electrosurgical excision procedure). Controls comprised the propensity-score matched pregnancies without pre-pregnancy surgery. The main outcome was the occurrence of preterm birth. The effect of prophylactic cervical cerclage on the risk of preterm birth after the excisional surgery was also examined using cases. Results: In the propensity-score matched population (cases, n = 1389; controls, n = 1389), cases exhibited a higher risk of preterm birth and preterm prelabor rupture of membranes (PROM), compared with controls (preterm birth: 25.3 versus 10.6%; preterm PROM: 14.0 versus 3.5%: both p <.0001). Odds ratios (OR; 95% confidence interval [CI]) for preterm birth at 22–27 weeks, 28–31 weeks, 32–33 weeks, and 34–36 weeks were 3.4 [1.8–6.5], 4.6 [2.7–7.7], 2.2 [1.4–3.5], and 2.1 [1.6–2.7], respectively. The association was stronger for preterm PROM at earlier gestational age (22–27 weeks, 28–31 weeks, 32–33 weeks, and 34–36 weeks: 5.2 [2.3–11.8], 7.1 [3.4–15.0], 3.8 [1.7–8.3], and 3.9 [1.8–4.6], respectively). In cases, 171 underwent the prophylactic cervical cerclage. The occurrence of preterm birth and preterm PROM was comparable between those with and without the cerclage (28.7 versus 24.2, and 12.9 versus 13.3%, respectively). Conclusions: Pre-pregnancy excisional cervical surgery was associated with the increased risk of preterm birth, especially before 32 weeks of gestation. The prophylactic cerclage did not reduce the risk of preterm birth.

KW - Cervical cerclage

KW - cervical lesions

KW - excisional surgery

KW - prelabor rupture of membranes

KW - preterm birth

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