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@article{Kyrgiou:2016:10.1136/bmj.i3633,
author = {Kyrgiou, M and Athanasiou, A and Paraskevaidi, M and Mitra, A and Kalliala, I and Martin-Hirsch, P and Arbyn, M and Bennett, P and Paraskevaidis, E},
doi = {10.1136/bmj.i3633},
journal = {BMJ},
pages = {1--15},
title = {Adverse obstetrical outcomes after local treatment for cervical pre-invasive and early invasive disease according to the cone depth: a systematic review and meta-analysis},
url = {http://dx.doi.org/10.1136/bmj.i3633},
volume = {354},
year = {2016}
}

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TY  - JOUR
AB  - Objective: To assess the effect of treatment for CIN on obstetric outcomes and to correlate this to the cone depth and comparison group used.MethodsDesign: Systematic review and meta-analysisData Sources: CENTRAL, MEDLINE, EMBASE from 1948 to April 2016.Eligibility Criteria: Studies assessing obstetric outcomes in women with or without a previous local cervical treatment.Data Extraction & Synthesis: Independent reviewers extracted the data and performed quality assessment using the Newcastle-Ottawa criteria. Studies were classified according to method and obstetric endpoint. Pooled risk ratios (RR) were calculated using a random-effect model and inverse variance. Inter-study heterogeneity was assessed with I2 statistics.Main outcomes and measures: Obstetric outcomes; preterm birth (PTB) (spontaneous and threatened), premature rupture of the membranes (pPROM), chorioamnionitis, mode of delivery, length of labour, induction of delivery, oxytocin use, haemorrhage, analgesia, cervical cerclage & cervical stenosis. Neonatal outcomes; low birth weight (LBW), neonatal intensive care unit (NICU) admission, stillbirth, APGAR scores and perinatal mortality.Results: Seventy-one studies were included (6338982 participants: 65082 treated-6292563 untreated). Treatment significantly increased the risk of overall (<37weeks)(10.7 v 5.4%, RR=1.78[1.60 to 1.98]), severe (<34/32weeks)(3.5 v 1.4%, RR=2.40[1.92 to 2.99]) and extreme (<30/28weeks)(1.0 v 0.3%, RR=2.54[1.77 to 3.63]) PTB. The magnitude of the effect was higher for techniques removing or ablating more tissue (<37weeks: CKC (RR=2.70[2.14 to 3.40]), LC (RR=2.11[1.26 to 3.54)], excision not otherwise specified (NOS) (RR=2.02[1.60 to 2.55]), LLETZ (RR=1.56[1.36 to 1.79]), ablation NOS (RR=1.46[1.27 to 1.66]). The risk of PTB increased with repeat treatment (13.2 v 4.1%, RR=3.78[2.65 to 5.39]) and with increasing cone depth (≤12/10mm: 7.1 v 3.4%, RR=1.54[1.09 to 2.18]; ≥10/12mm: 9.8 v 3.4%, RR=1.93[1.62
AU  - Kyrgiou,M
AU  - Athanasiou,A
AU  - Paraskevaidi,M
AU  - Mitra,A
AU  - Kalliala,I
AU  - Martin-Hirsch,P
AU  - Arbyn,M
AU  - Bennett,P
AU  - Paraskevaidis,E
DO  - 10.1136/bmj.i3633
EP  - 15
PY  - 2016///
SN  - 0959-8138
SP  - 1
TI  - Adverse obstetrical outcomes after local treatment for cervical pre-invasive and early invasive disease according to the cone depth: a systematic review and meta-analysis
T2  - BMJ
UR  - http://dx.doi.org/10.1136/bmj.i3633
UR  - http://hdl.handle.net/10044/1/34087
VL  - 354
ER  -

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