LLETZ Specimen Fragmentation: Impact on Diagnosis, Outcome, and Implications for Training

Purpose

This study was designed to assess fragmentation of Large loop excision of the transformation zone (LLETZ) specimens, its influence on short-term cytological outcome, and the risk factors for specimen fragmentation, as we well as trainee performance on clinical outcome.

Method

This retrospective study was performed at a cancer center. Women who underwent LLETZ for suspected high-grade cervical intra-epithelial neoplasia (CIN) over a 5-year period were included. Patients were identified through a regional database. Data were obtained from hospital and regional databases. Fisher’s exact test was used.

Results

75 % of all specimens were obtained intact. When the LLETZ specimen was intact, 89 % of smear tests were reported as negative, against 86 % when the specimen was fragmented. Fragmentation was significantly associated with high-grade smear results at 6 months. Trainee status was significantly related to specimen fragmentation.

Conclusion

Fragmentation of LLETZ specimens is associated with an increased likelihood of obtaining a high-grade smear at 6 months post treatment. Enhancing the colposcopy training may help improve clinical outcome.     

Direct colposcopic vision used with the LLETZ procedure for optimal treatment of CIN: results of joint cohort studies

Purpose

To assess the value of direct colposcopic vision (DCV) for optimizing large loop excision of the transformation zone (LLETZ) for the treatment of cervical intraepithelial neoplasia (CIN).

Methods

Data from 648 patients who underwent excisional procedures for CIN and were included in two previously published cohort studies were retrospectively reviewed. Women who had a LLETZ were included for analysis (n = 436). Margin status, surgical specimen dimensions and volume were analysed according to the use of colposcopy during procedure.

Results

Compared to LLETZ guided by previous colposcopy report only, and to LLETZ performed immediately after colposcopy, DCV allowed for a significantly higher rate of clear margins: 33 (52.4 %), 104 (68.0 %) and 142 (84.5 %), respectively (p < 0.001). It also allowed for a significantly higher probability of achieving both negative margins and depth of specimen <10 mm: 10 (15.9 %) cases, 47 (30.7 %) cases and 125 (74.4 %) cases, respectively (p < 0.001). In multivariate analysis, when compared with the use of previous colposcopy report or with colposcopy immediately before the LLETZ, DCV allowed for a significantly higher probability of negative margins (AOR: 4.61; 95 % CI: 2.37–8.99 and AOR: 2.55; 95 % CI: 1.47–4.41), combined negative margins and depth <75th percentile (AOR: 3.67; 95 % CI: 1.97–6.86 and AOR: 3.05; 95 % CI: 1.91–4.87) and combined negative margins and volume <75th percentile (AOR: 12.96; 95 % CI: 5.99–28.05 and AOR: 6.16; 95 % CI: 3.75–10.14), respectively.

Conclusions

When used with the LLETZ procedure, DCV allows for optimal outcomes in terms of negative resection margins, and minimized depth and volume of the excised specimen; and should therefore be recommended.     

Subjective assessment of ovarian masses using pattern recognition: the impact of experience on diagnostic performance and interobserver variability

Purpose

To compare diagnostic performance and interobserver variability in a group of 36 examiners, with four different levels of experience.

Methods

Nine junior trainees, eight level I senior trainees, 11 level II senior gynecologists, and eight level III expert sonologists classified 105 ultrasound images of adnexal masses into three subgroups of ovarian lesions (malignancies, functional cysts, and dermoid cysts).

Results

The level III sonologists obtained the best diagnostic results together with the lowest interobserver variability (κ?=?0.70, SD?=?0.04). They achieved significantly better results in comparison with the junior trainees and also the senior trainees (κ?=?0.51, SD?=?0.12, p?p?p?=?0.70). There were no significant differences between senior and junior trainees (p?=?1.0) and both groups achieved a significantly poorer diagnostic performance in comparison with the level II observers (p?p?Conclusions Diagnostic performance of pattern recognition significantly improves with an increasing level of experience, emphasizing the importance of standardized ultrasound training programs with supervision by experts.     

Prediction, based on resection margins, of long-term outcome of cervical intraepithelial neoplasia 3 treated by Shimodaira-Taniguchi conization

Purpose

The aim of the present study was to analyze the long-term outcome of cervical intraepithelial neoplasia 3 (CIN 3) after treatment with the Shimodaira-Taniguchi conization procedure, based on the status of the resection margins.

Methods

In the Osaka University Hospital, conization using the Shimodaira-Taniguchi procedure has been routinely performed for CIN 3. Medical records of patients during the period from 2001 to 2008, whose post-conization diagnosis was CIN 3, were retrospectively analyzed for outcome versus margin status.

Results

During the median follow-up period of 565?days (range 34–3,013), CIN disease was again detected in 14 of 243 patients; it was found in 7 patients among 198 margin-negative cases, and in 7 patients among 45 margin-positive cases. There was a significant difference in the reappearance rate demonstrated between the cases with positive and negative margins (p?=?0.0018). Among the patients whose first follow-up post-conization cytology was normal, recurrence-free probability was significantly higher in margin-negative cases than in margin-positive ones (hazard ratio, 5.19; 95% CI, 1.175–22.994; p?=?0.0041).

Conclusion

For the first time, we demonstrate that after treatment of CIN 3 lesions by Shimodaira-Taniguchi conization the status of the resection margin was a significant predictor for long-term outcome.     

Sialic acid levels in the blood in pregnant women with impaired glucose tolerance test

Purpose

Gestational diabetes (GDM) is a metabolic disease characterized by the impairment of glucose tolerance during pregnancy. Sialic acid (SA) is a component of glycolipid and glycoproteins found in hormone and enzymes in serum and tissues and high serum SA levels are observed in diabetic patients.

Methods

Serum SA levels were investigated in three groups, namely 61 normal pregnant women with normal 50 gr glucose loading test (group 1: gr 1), 36 patients with high 50 gr test values and normal 100 gr test (group 2: gr 2: group with impaired glucose tolerance test, IGT), and 8 patients with diagnosis of GDM (group 3:gr 3).

Results

According to Kruskal–Wallis test, significant difference was observed in SA levels between gr1 and gr2–gr3 (p?=?0.001). Difference was observed between groups with respect to age (p?p?=?0.001), BMI (p?=?0.001), and diabetes history in the family (p?=?0.001) (Table?1).

Do intrauterine growth restricted fetuses of the hypertensive and normotensive mothers differ from each other?

Purpose

To investigate if normotensive and hypertensive patients with intrauterine growth restricted (IUGR) fetuses were different with respect to maternal and fetal characteristics and Doppler flow.

Methods

The records of patients with IUGR fetuses who had to be delivered before 34th gestational week because of fetal distress were examined. Early Doppler abnormalities were defined as increased umbilical artery resistance and redistribution of blood flow in the middle cerebral artery while late Doppler abnormalities were defined as the absence or reversal of umbilical artery blood flow and Doppler flow changes in venous Doppler. t Test, Chi-square test and Mann–Whitney U test were used for the comparison of data as appropriate. p?<?0.05 was considered statistically significant.

Results

Thirty-six patients were hypertensive while 42 were normotensive. Gestational week at admission for hypertensive and normotensive groups (30.8?±?3.6 vs. 32.3?±?3.1) (p?=?0.057), time to delivery (7.1?±?12.6 vs. 4.3?±?9.1?days) (p?=?0.267) and gestational week at delivery (31.8?±?3.1 vs. 32.9?±?2.9) (p?=?0.117) were similar. Birth weight was significantly lower (1242?±?534 vs. 1516?±?504?g) (p?=?0.02) in the normotensive group. The frequency of having oligohydramnios (64.2?% for normotensive and 44.4?% for hypertensive patients) (p?=?0.079) was similar in both groups. Early Doppler abnormalities were more common in hypertensive group (75 vs. 40.5?%) (p?=?0.001) while late Doppler abnormalities were more common in normotensive group (25 vs. 59.5?%) (p?=?0.001).

Conclusion

Birth weight was lower and late Doppler abnormalities were more common in the normotensive group while early Doppler abnormalities were more common in hypertensive group.     

The role of CPK isoenzymes in predicting extrauterine early pregnancy

Objective

To evaluate the ability of Creatine phosphokinase (CPK) levels and CPK-MB proportion to differentiate between extra and intrauterine of very early gestations with unknown location.

Materials and methods

The study is case?Ccontrol. CPK levels and CPK-MB proportion in 51 women with extrauterine pregnancies were compared to those in 28 women with early intrauterine pregnancies.

Results

No significant difference was found between women with extrauterine pregnancies and early intrauterine pregnancies in the levels of CPK (80.9?±?62.1 vs. 74.9?±?51.5; p?=?0.66) and CPK-MB proportion (16.2?±?10.1% vs. 15.1?±?11.1%; p?=?0.86).

Conclusion

CPK and CPK-MB proportion determinations do not contribute to the clinical differentiation between early intra and extrauterine pregnancies.     

A pilot study comparing efficacy of a cervical intraepithelial neoplasia excisor with loop electrosurgical excision procedure

Objective

To determine whether the proportion of incomplete resection of cervical intraepithelial neoplasia (CIN 1-3) may be reduced by CIN Excisor compared with loop excision of the transformation zone (LLETZ).

Study design

A prospective trial during a 2-year period at a district general hospital in London, United Kingdom, including 420 women scheduled for treatment due to CIN, after colposcopy guided biopsy results. This study was expected to demonstrate a statistically significant difference (p < 0.05) in the proportion of women with clear histopathological resection margins after treatment with CIN Excisor compared with LLETZ. Chi-square or Fisher's exact test were used to compare histopathological resection margins in the CIN Excisor and LLETZ groups.

Results

Overall, there is strong evidence of a difference in the proportion of histopathological specimens with clear resection margins for the CIN Excisor group, compared with the LLETZ group (201/210, 95.7% versus 180/210, 85.7%: p < 0.001). Sub-analysis within the two groups, of the proportion of histopathological specimens with clear resection margins in relation to CIN grades, revealed a statistically significant difference in favour of the CIN Excisor group for CIN 1 (99/103, 96.1% versus 82/95, 86.3%: p = 0.01), and CIN 2 (73/77, 94.8% versus 68/80, 85%: p = 0.04). There is a numerical difference in the proportion of clear resection margins in favour of the CIN Excisor for CIN 3 (29/30, 96.7% versus 30/35, 85.7%), but this difference was not statistically significant (p = 0.21). Perioperative complications were similar between the two groups.

Conclusion

CIN Excisor achieved better results than LLETZ for treatment of CIN 1-3 with respect to clear histopathological resection margins. However, further studies including a larger number of women treated for CIN 3 are needed before firm conclusions are drawn.     

Estimating the impact of pelvic immaturity and young maternal age on fetal malposition

Objective

Fetal malposition, specifically occiput posterior and transverse (OP/OT), is associated with higher intra-partum morbidity. We tested the hypothesis that young maternal age and pelvic immaturity are risk factors for fetal malposition.

Methods

In a cohort study of all nulliparous teen (??18?years) deliveries over a 4-year period at one institution, fetal head position at time of delivery was collected and correlated with maternal characteristics and outcome data. Using Risser staging observations, pelvic maturity age was set at 16, and accordingly, the women were divided into two groups (younger vs. older teens). Analysis was performed using Fisher??s exact, student t test, and logistic regression modeling.

Results

Older teen mothers (16?C18?years, n?=?609) had higher rates of malposition (22 vs. 12?%, p?=?0.02) when compared with younger teens (??15?years, n?=?98). Among all women with a malpositioned fetus, older teens had a higher body mass index (BMI: 32.6?±?6.7 vs. 28.5?±?3.5, p?=?0.04) and subsequent need for cesarean delivery (69 vs. 33?%, p?=?0.02) when compared with their younger counterparts. Although younger teens were more successful in having a vaginal delivery (67?%) with an OP/OT position, it was at the expense of a 25?% rate of severe perineal laceration (third/fourth degree).

Conclusion

Obesity, and not young maternal age or pelvic immaturity, is associated with fetal malposition. The direct association with increasing pre-pregnancy BMI and the long-term impacts of the high rates of cesarean delivery in this young population underscores the need for more public health focus.     

Comparison of uterine artery Doppler in pregnant women with thrombophilia treated by LMWHs and without thrombophilia

Objective

The aim of this study was to use uterine artery Doppler ultrasonography to investigate the cases of women with thrombophilia who used LMWH during the 18?C22-week period of gestation.

Methods

This retrospective study was conducted at our university between January 2005 and July 2010. 64 patients were treated with low-dose LMWHs (enoxaparine 40?mg) from the beginning of pregnancy until 36?weeks of gestation. Fifty control subjects were also included in this study. Transabdominal ultrasound examination and bilateral uterine artery Doppler measurements pulsatility index (PI), resistive index (RI), and systole/diastole measurement (S/D) were performed during the 18?C22-weeks period of gestation.

Results

No significant differences were found between the groups with respect to maternal age or gestational age at the time of uterine artery Doppler. However, the mean PI (1.07?±?0.46 for LMWH group and 0.91?±?0.31 for control, p?=?0.036) and the mean RI (0.59?±?0.12 for LMWH group and 0.54?±?0.10 for control, p?=?0.021) were significantly higher in the trombophilia group.

Conclusion

Women with trombophilia still have an increased mean PI and RI, as determined by uterine artery Doppler ultrasonography during the 18-22-week period of gestation, even if they use LMWH.     

Weekly paclitaxel in heavily pretreated ovarian cancer patients: does this treatment still provide further advantages?

Objective

To evaluate the disease control rate (DCR) in heavily pretreated and relapsed ovarian cancer patients re-challenged with a weekly paclitaxel schedule and to establish whether a correlation between dose intensity, progression-free interval (PFI) and overall survival (OS) exists.

Methods

Retrospective data were collected from 30 heavily pretreated metastatic ovarian cancer patients who received 80?mg/m²/week paclitaxel regimen.

Results

The treatment was well tolerated and showed a DCR in 70% of the patients, with only one case of grade 3 hematological toxicity. One patient (3%) showed a complete response, 15 patients (50%) a partial response and five patients (17%) a stabilization of their disease. The regimen was mostly used as a fourth-line chemotherapy (range 2?C7). The median dose intensity in responding patients was 57.5?mg/m²/week and in those with progressive disease 49.7?mg/m²/week. (p?=?0.20). PFI and OS were increased in the responder patient groups with a log-rank test of 25.64 (p?<?0.001) and 15.10 (p?=?0.0001), respectively.

Conclusions

Weekly administration of paclitaxel was active and well tolerated as a salvage therapy for heavily pretreated ovarian cancer patients.     

Characteristics and prognosis of coexisting adnexa malignancy with endometrial cancer: a single institution review of 51 cases

Objective

To explore and compare the differences in the clinicopathological characteristics and prognosis of synchronous primary endometrial and ovarian cancers with primary endometrial cancer metastatic to adnexa.

Materials and methods

Between January 1997 and December 2009, 51 cases with endometrial cancer simultaneously with adnexa malignancy were identified. Among them, there were 18 cases with synchronous primary cancers of the endometrium and ovary (Group A) and 33 cases with primary endometrial cancer metastatic to the adnexa (Group B). Clinical and pathologic information was obtained from medical records. Parametric methods were used to compare clinical and pathologic features. Kaplan?CMeier survival analysis was performed and compared using log-rank test.

Results

The mean age at diagnosis of the disease was 56.6?±?10.8?years (range 34?C76?years) in Group A and 53.1?±?9.5?years (range 37?C76?years) in Group B. The two groups?? distribution of preoperative image findings, size of endometrial lesion, myometrial invasion, unilateral or bilateral, cervix invasion, and postoperative radiation existed significant differences. With a mean follow-up time of 4.3?±?3.4?years (range 2?C11?years), 5-year overall survival (OS) was 75 and 56% in Groups A and B, respectively (p?=?0.034). The univariate analysis showed only postoperative radiation and synchronous tumors were independent factors which affected OS (p?=?0.015; p?=?0.034) and progression-free survival (PFS) (p?=?0.015; p?=?0.036), respectively. Not any feature was revealed by multivariate analysis as independent prognostic factors.

Conclusion

Our results showed that OS and PFS of synchronous primary ovarian cancer in patients with endometrial cancer is better than those with ovarian metastasis patients. Pre- and intra-operative, intensive and careful assessment, and strict and continuous postoperative surveillance should pay attention to the endometrial cancer patients who preserved ovary for having possibility of coexisting occult ovarian lesions.     

Contributing factors for the incidence of aneuploidy in older patients undergoing intracytoplasmic sperm injection cycles

Purpose

To evaluate different factors that might affect the incidence of embryo aneuploidy in intracytoplasmic sperm injection cycles (ICSI).

Methods

One hundred and ninety ICSI cycles in conjunction with preimplantation genetic screening (PGS) were included. The influence of the following variables on the aneuploidy incidence was evaluated: (i) maternal and (ii) paternal ages, (iii) dose of FSH administered, (iv) dose of FSH per number of retrieved matured oocytes (FSH/MII), (v) serum 17β-oestradiol levels on the ovulation trigger day, (vi) aspirated follicles and (vii) retrieved oocytes.

Results

A total of 440 embryos were successfully biopsied, of which 240 were considered euploid and 200 were considered aneuploid. The paternal age (Slope: 0.2, p?=?0.372), total dose of FSH (Slope: 0.2, p?=?0.218), FSH/MII (Slope: 0.1, p?=?0.296) and 17β-oestradiol levels (Slope: 0.2, p?=?0.378) were not correlated with the presence of aneuploidy. However, the maternal age (Slope: 1.7, p?<?0.01), aspirated follicles (Slope: 1.9, p?<?0.01) and retrieved oocytes (Slope: 2.6, p?<?0.01) were negatively correlated with the incidence of aneuploidy.

Conclusions

Even in older patients, lower oocyte yields may represent a more appropriate response to ovarian stimulation, allowing the most competent follicles and oocytes to develop and thereby reducing the occurrence of embryo aneuploidy.     

Follicular fluid high density lipoprotein-associated micronutrient levels are associated with embryo fragmentation during IVF

Purpose

To investigate whether follicular fluid lipid-soluble micronutrients are associated with embryo morphology parameters during IVF.

Methods

Follicle fluid and oocytes were obtained prospectively from 81 women. Embryo morphology parameters were used as surrogate markers of oocyte health. HDL lipids and lipid-soluble micronutrients were analyzed by high-pressure liquid chromatography. Non-parametric bi-variate analysis and multivariable ordinal logistic regression models were employed to examine associations between biochemical and embryo morphology parameters.

Results

Follicular fluid HDL cholesterol (r?=??0.47, p?<?0.01), α-tocopherol (r?=??0.41, p?<?0.01), δ-tocopherol (r?=??0.38, p?<?0.05) and β-cryptoxanthine (r?=??0.42, p?<?0.01) are negatively correlated with embryo fragmentation. Ordinal logistic regression models indicate that a 0.1 μmol/L increase in β-cryptoxanthine, adjusted for γ-tocopherol, is associated with a 75% decrease in the cumulative odds of higher embryo fragmentation (p?=?0.010).

Conclusion

Follicular fluid HDL micronutrients may play an important role in the development of the human oocyte as evident by embryo fragmentation during IVF.     

Combination of recombinant follicle stimulating hormone with human menopausal gonadotrophin or recombinant luteinizing hormone in a long gonadotrophin-releasing hormone agonist protocol: a retrospective study

Purpose

To assess the effect of supplementation with recombinant human luteinizing hormone (rhLH) for patients treated either with recombinant follicle stimulating hormone (rFSH) plus rhLH or with rFSH plus human menopausal gonadotrophin (HMG) in a long gonadotrophin-releasing hormone (GnRH) agonist-stimulation protocol.

Methods

A single-centre, retrospective analysis of patients with hypo responsiveness to a long GnRH agonist protocol (n?=?174), with consecutive in-vitro fertilization or intracytoplasmic sperm injection cycles, compared the outcomes of long luteal GnRH agonist ovarian stimulation using rFSH combined with HMG (n?=?100) versus rFSH combined with rhLH (n?=?74). The endpoints included clinical pregnancy, number of oocytes retrieved, and total gonadotrophin dose.

Results

Significantly more clinical pregnancies were achieved after stimulation with rFSH and rhLH than after stimulation with rFSH and HMG (35.1 vs. 19%, p?<?0.01). More oocytes were recovered (13.1 vs. 11.3, p?=?0.024) with less FSH utilized in the rFSH and rhLH group than in the rFSH and HMG group (2706.4 vs. 4134.2?U, p?<?0.001).

Conclusions

Use of rFSH combined with rhLH in long GnRH agonist assisted reproductive technology (ART) cycles was associated with more clinical pregnancies, recovery of more oocytes, and reduction in gonadotrophin use, suggesting that the superior purity and consistency of rFSH and rhLH may result in better clinical outcomes.     

IVF/ICSI outcomes of the OCP plus GnRH agonist protocol versus the OCP plus GnRH antagonist fixed protocol in women with PCOS: a randomized trial

Objective

To compare the IVF/ICSI outcomes of the long GnRH agonist and the fixed GnRH antagonist protocol in women with PCOS.

Design

Randomized controlled trial.

Setting

Baskent University Department of Obstetrics and Gynecology.

Patients

Three hundred women with PCOS.

Interventions

IVF/ICSI following the long GnRH agonist down-regulation or the fixed GnRH antagonist protocols.

Main outcome measures

Ongoing pregnancy rates.

Results

Ongoing pregnancy rates were 36.4?% in the OCP?+?GnRH agonist group and 35.9?% in the OCP?+?GnRH antagonist group (p?>?0.05). Progesterone levels on the day of hCG (0.76?±?0.71 vs. 0.58?±?0.50), endometrial thickness on the day of hCG (11.57?±?2.50 vs. 10.50?±?2.01), total gonadotropin used (1388.71?±?482.39 vs. 1253.25?±?415.81), and duration of COH (9.07?±?1.96 vs. 8.39?±?1.75) were significantly lower in the OCP?+?GnRH antagonist group.

Conclusion

The OCP?+?long GnRH agonist and the OCP?+?fixed GnRH antagonist protocols yield similar ongoing pregnancy rates in women with PCOS. Although this study consisting three hundred patients, seems to be large enough in a single center, we were not able to reach to the actual size of power analysis which was approximately 3,000.     

Factors contributing to intra-uterine fetal death

Purpose

We aimed in this research to explore factors contributing to the occurrence of intra-uterine fetal death (IUFD).

Methods

The study was conducted between 1st January 2008 and 31st December 2009 in the Department of Obstetrics and Gynecology at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Patients who were diagnosed to have IUFD at ≥24?weeks of gestation and those whose dead fetuses were found to weigh ≥500?g after delivery were eligible to be included. 138 patients with IUFD and 237 controls with alive fetuses were enrolled. Data were collected from printed and computerized medical records of participants. Factors that may have contributed to the occurrence of IUFD were explored. Comparisons between various risk factors and outcomes of the two groups were done. p value was statistically significant if ≤0.05.

Results

Patients who did not receive antenatal care (ANC) services are at 70?% increased risk for developing IUFD (OR 0.31, p?<?0.0001). Risk of IUFD increases 25-fold with the occurrence of abruption placenta (OR 25.81, p?≤?0.0001), tenfolds with the occurrence of intra-uterine growth restrictions (OR 10.78, p?=?0.04) and threefolds with the presence of hypertensive disorder in pregnancy (OR 3.17, p?=?0.04). Finally, patients carrying IUFD fetuses are at higher risk to develop labor complications compared with their controls (p?≤?0.0001).

Conclusion

Despite the difficulty in predicting IUFD occurrence, it appears that carefully implemented ANC and timely management of at risk patients may contribute to its prevention.     

Pregnancy outcomes and superiorities of prophylactic cervical cerclage and therapeutic cervical cerclage in cervical insufficiency pregnant women

Purpose

To compare the clinical effect of prophylactic cervical cerclage and therapeutic cervical cerclage on pregnancy outcome and operative factors in cervical insufficiency pregnant women.

Methods

A retrospective study was conducted between June 2014 and September 2016 in a maternity ward, which included women who have had a single pregnancy and have been carried out a McDonald cerclage. All maternal medical records were reviewed. The efficacy of cerclage for preventing late foetal loss was assessed using multivariable logistic regression analysis.

Results

The results showed that there were significant associations between cerclage operations and pregnancy outcomes in the duration of pregnancy prolongation in terms of live births, gestation age, live birth and cesarean section rate. In prophylactic cervical cerclage, compared with therapeutic cervical cerclage, cervical length before surgery was significantly longer (32.7?±?5.8 vs 19.9?±?7.3 mm, p?<?0.0001). Mean operative duration and postoperative length of hospital stay in prophylactic cervical cerclage were shorter than those in therapeutic cervical cerclage (22.1?±?10.3 vs 28.9?±?13.0 min, p?=?0.0241 and 5.6?±?1.8 vs 7.0?±?2.8 days, p?=?0.0354), respectively. Compared with therapeutic cerclage, prophylactic cerclage had more advantages in gestational age at delivery (35.2?±?5.5 and 31.7?±?6.5 weeks, p?=?0.0061), deliveries?<?37 gestational weeks (40 vs 69.2%, p?=?0.0159), live births (93.3 vs 69.2%, p?=?0.0143) and the duration of pregnancy prolongation in terms of live births (19.5?±?5.0 vs 12.0?±?8.2 weeks, p?=?0.0002). There was a higher cesarean section rate in prophylactic group than that in therapeutic group (50 vs 25.6%, p?=?0.0383). The logistic analysis showed that the cervical length before surgery was the only independent prognostic factor [OR 2.860 (1.425, 5.742) p?=?0.0031] for pregnancy outcome, and that is the cervical length before surgery affected late foetal loss.

Conclusions

Our study suggests that, both prophylactic cervical cerclage and therapeutic cervical cerclage reduce the incidence of recurrent abortion or preterm birth and efficiently extend the length of the pregnancy with live births. The prophylactic cervical cerclage has more advantages in operative time, length of hospital stay after surgery, gestational age at delivery, live births and preterm birth. The length of the cervical before surgery is an independent risk factor for pregnancy outcomes when pregnant women appear in the cervical shortening is less than normal. Cervical cerclage is an effective surgical technique to prevent recurrent abortion or late foetal loss.

     

Impact of conization type on the resected cone volume: results of a retrospective multi-center study

Purpose

The extent of conization seems to influence the risk of preterm birth. The aim of this study was to compare the cone volume after surgical resection with large loop excision of the transformation zone (LLETZ) and cold knife conization (CKC).

Methods

The present retrospective multi-center study comprises 804 consecutive women, who underwent LLETZ (n = 412) or CKC (n = 392) between 2004 and 2009. Univariate and multivariable analyses were performed to compare cone volumes removed by LLETZ and CKC and identify independent risk factors for large cone volume.

Results

The median resected cone volume after LLETZ was significantly smaller [1.6 cm³ (0.8–2.9)] than after CKC [2.1 cm³ (1.4–3.5)] (<0.0001). Complete resection rates were comparable in both groups. Conization method, cone depth, and institution type were independent risk factors for removal of a large cone volume.

Conclusion

CKC removes larger cone volumes than LLETZ without the advantage of higher complete resection rates.