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Fertility and Early Pregnancy Outcomes Following Conservative Treatment for Cervical Intraepithelial Neoplasia and Early Cervical Cancer

Educational Objective
Based on this JAMA Oncology Clinical Evidence Synopsis and the accompanying materials, understand how to respond to the following clinical question: Does local conservative treatment for cervical intraepithelial neoplasia and early invasive cervical cancer adversely affect successful conception and early pregnancy outcomes in the first and second trimester (<24 weeks of gestation)?
1 Credit CME
Abstract

Clinical Question  Does local conservative treatment for cervical intraepithelial neoplasia and early invasive cervical cancer adversely affect successful conception and early pregnancy outcomes in the first and second trimester (<24 weeks of gestation)?

Clinical Application  Local cervical treatment does not adversely affect fertility or first trimester miscarriage, although it is associated with a significant increase in the risk of second trimester miscarriages.

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Article Information

Corresponding Author: Maria Kyrgiou, MSc, PhD, MRCOG, Third Floor, Institute of Reproductive and Developmental Biology, Surgery and Cancer, Imperial College, Hammersmith Campus, Du Cane Road, W12 0NN, London, England (m.kyrgiou@imperial.ac.uk).

Published Online: June 23, 2016. doi:10.1001/jamaoncol.2016.1839

Conflict of Interest Disclosures: None reported.

Funding/Support: This work was supported by a BSCCP Jordan/Singer Award (No. P47773); the Imperial College Healthcare Charity (No. P47907); the Imperial Healthcare National Health Service Trust National Institute for Health Research Biomedical Research Centre (No. P45272); and the Genesis Research Trust (No. P55549).

Role of the Funder/Sponsor: The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We acknowledge Marc Arbyn, MD (Scientific Institute for Public Health, Brussels, Belgium); Maria Paraskeviaidi, BSc (Imperial College London, England); Antonis Athanasiou (University Hospital of Ioannina, Greece); Pierre Martin-Hirsch, MBChB, MRCOG, MD (Lancaster University, City of Lancaster, England); and Philip Bennett, BSc, MBBS, MD, PhD, FRCOG (Imperial College London, London, England), for work on the original Cochrane review; as well as Clare Jess (Cochrane Collaboration) for editorial support. Ms Jess did not receive compensation for her contributions.

References
1.
Kyrgiou  M, Koliopoulos  G, Martin-Hirsch  P, Arbyn  M, Prendiville  W, Paraskevaidis  E.  Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis.  Lancet. 2006;367(9509):489-498.PubMedGoogle ScholarCrossref
2.
Arbyn  M, Kyrgiou  M, Simoens  C,  et al.  Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis.  BMJ. 2008;337:a1284.PubMedGoogle ScholarCrossref
3.
Kyrgiou  M, Mitra  A, Arbyn  M,  et al.  Fertility and early pregnancy outcomes after conservative treatment for cervical intraepithelial neoplasia.  Cochrane Database Syst Rev. 2015;9:CD008478.PubMedGoogle Scholar
4.
Kyrgiou  M, Mitra  A, Arbyn  M,  et al.  Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis.  BMJ. 2014;349:g6192.PubMedGoogle ScholarCrossref
5.
Castanon  A, Landy  R, Brocklehurst  P,  et al; PaCT Study Group.  Risk of preterm delivery with increasing depth of excision for cervical intraepithelial neoplasia in England: nested case-control study.  BMJ. 2014;349:g6223.PubMedGoogle ScholarCrossref
6.
Kyrgiou  M, Valasoulis  G, Stasinou  SM,  et al.  Proportion of cervical excision for cervical intraepithelial neoplasia as a predictor of pregnancy outcomes.  Int J Gynaecol Obstet. 2015;128(2):141-147.PubMedGoogle ScholarCrossref
7.
Kyrgiou  M, Arbyn  M, Martin-Hirsch  P, Paraskevaidis  E.  Increased risk of preterm birth after treatment for CIN.  BMJ. 2012;345:e5847.PubMedGoogle ScholarCrossref
8.
Mitra  A, MacIntyre  DA, Lee  YS,  et al.  Cervical intraepithelial neoplasia disease progression is associated with increased vaginal microbiome diversity.  Sci Rep. 2015;5:16865.PubMedGoogle ScholarCrossref
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