Survey: the management of pregnant women with a history of excisional treatment of the uterine cervix for cervical intra-epithelial neoplasia

摘要

The purpose of this study is to gauge the management of pregnant women with a past history of cervical excisional treatments for cervical intra-epithelial neoplasia (CIN). A postal survey of 120 consultant obstetricians and gynaecologists in the northwest of England was done. The response rate was 41.7%. Thirty-seven respondents (74%) agreed with the evidence that cervical excisional treatment increases the risk of late miscarriage, preterm labour, premature rupture of the membranes and spontaneous rupture of the membranes at term. Thirty-one (62%) think that cervical assessment during pregnancy in women who had excisional treatments is not essential, nevertheless, 72% of the respondents utilise transvaginal ultrasonography alone or in combination with other methods to assess the cervix in these women. Seventeen (34%) assess the cervix monthly and nineteen (38%) carry out variable assessments ranging between once in the first trimester and every 6–8 weeks. Thirty-one (62%) offer cervical cerclage and 28 (56%) will offer it between 13–16 weeks gestation. Twenty-four (48%) would offer preconception transabdominal cervical cerclage to at-risk women. Forty (80%) do not believe that previous excisional treatment will alter the vaginal flora and only eight (16%) perform high vaginal swabs. There is a lack of consensus and consistency in the cervical assessment for the prediction of the risk of preterm birth in women who had cervical excisional treatments for CIN. Transvaginal ultrasonography alone or in combination with other methods is the most favoured technique in cervical assessment. The majority of the respondents offer cervical cerclage. In the presence of evidence that cervical excisional treatment for CIN carries a real risk of pregnancy loss and morbidity, there is a need for an agreed and standardised strategy in cervical assessment and intervention techniques.