Outcome of pregnancies after cold-knife conization of the uterine cervix during pregnancy

OBJECTIVE: To determine the incidence of cervical intraepithelial neoplasia (CIN) in pregnancy and to determine the outcome of pregnancies in women treated by cold knife conization during pregnancy. METHODS: The authors retrospectively studied the cases of 19,807 pregnant patients, who presented to the 1st Department of Obstetrics and Gynecology Semmelweis University Faculty of Medicine between January 1, 1993 and December 31, 1997. Of these, there were 1,513 spontaneous abortions, 6,170 artificial abortions and 12,124 deliveries. Cytological evidence of a high-grade squamous intraepithelial lesion (LGSIL) was found in 48 pregnant patients. A low-grade squamous intraepithelial lesion (LGSIL) was found in 55 pregnant patients. All pregnant patients with HGSIL including those with satisfactory and nonsatisfactory colposcopical examinations underwent diagnostic cold knife conization during pregnancy in the second trimester. A gynecologic pathologist (Dr. Zs. Csapó) reviewed the histopathological sections. RESULTS: Overall, 44 patients had CIN, three patients had microinvasive carcinoma (FIGO stage I/A1), and one patient had neither CIN nor invasive carcinoma in the HGSIL group. Among the 48 pregnant patients with HGSIL, there were two spontaneous abortions occurring during the 21st and the 22nd gestational weeks respectively, so the pregnancy loss rate was 4.2%. Forty patients (83%) delivered at term and six patients (12.5%) at preterm. Twenty-four patients (52%) delivered vaginally and 22 (48%) by cesarean section. Comparing this data with the control group consisting of pregnant patients who had LGSIL, the difference between the two group as regards the total number of adverse pregnancy outcome cases was not significant. In the three patients with microinvasive cervical carcinoma (FIGO stage I/A1), elctive cesarean section was performed, followed by an immediate abdominal hysterectomy at term. CONCLUSION: The incidence of CIN in pregnancy was 0.22%. The incidence of microinvasive cervical carcinoma was 0.015%. Pregnant patients with CIN who underwent cold knife conization during pregnancy were not at increased risk of adverse pregnancy outcome, however they were at increased risk of cesarean delivery.