scholarly journals Correlation between cervical excisional procedures and the risk of preterm birth in subsequent pregnancies

2021 ◽  
Vol 16 (S3) ◽  
pp. 22-27
Author(s):  
Cezara Diana MUGESCU ◽  
◽  
Brînduşa Ana CIMPOCA-RAPTIS ◽  
Anca Marina CIOBANU ◽  
Radu BOTEZATU ◽  
...  

Cervical excisional procedures stand as an important risk factor for preterm birth (PTB) in subsequent pregnancies in various articles in the medical literature. We performed an evidence-based review of the obstetrical outcomes succeeding excisional procedures for cervical dysplasia as follows: we reviewed 16 studies published between 2015 and 2020 that assessed whether there is an association between excisional cervical procedures and unfavorable obstetrical outcomes. Nevertheless, there are several other aspects of the problem, taken into account as possibly responsible for increasing the risk of PTB, as the grade of the dysplasia, the effect of depth/length/volume of the excised cone specimen, prophylactic procedures for the prevention of PTB, age, interval conization-pregnancy. The majority of the authors suggested an association between excisional procedures and preterm birth or other obstetrical events. However, some of them did not find statistically significant data in order to strongly affirm a correlation between conization and PTB, or, on the contrary, disproved the given hypothesis. There is no consensus regarding cervical excisions as being an individual risk factor for PTB, therefore more studies need to be conducted in order to come to a strong, universal conclusion.

Author(s):  
P Bachkangi ◽  
AH Taylor ◽  
JC Konje

Preterm birth (PTB) affects 9.6% of pregnancies worldwide and is associated with a very high perinatal mortality that depends on the gestational age at delivery. As a result, PTB has a significant health and financial impact on health systems, families and societies. Its aetiology is not fully understood, but in most cases it is multifactorial, with several maternal, paternal, and epidemiological factors associated with increased risk. Other factors include parental ethnicity, maternal age and body mass index, socioeconomic status, and where the families live. This review examines the influence of ethnicity as an individual risk factor for PTB. It also explores its influence on the epidemiology of PTB and demonstrates that data on certain ethnicities are lacking, despite the fact that these ethnic clusters are within the very ‘high-risk groups’ that are adequately represented in some Western societies. This review examines the influence of ethnicity as an individual risk factor for PTB and also explores its influence on the different epidemiological aspects. A thorough revisit of the ethnic epidemiology unveiled other unnoticed risk factors that if addressed appropriately prematurity can be prevented. Moreover, certain ethnicities were not within the attention of researchers, despite the facts that they are very ‘high-risk groups’ and are also adequately represented in some Western societies.


2017 ◽  
Vol 176 (4) ◽  
pp. 371-378 ◽  
Author(s):  
Hyemi Kwon ◽  
Min Ji Jeon ◽  
Won Gu Kim ◽  
Suyeon Park ◽  
Mijin Kim ◽  
...  

Objective Papillary thyroid microcarcinoma (PTMC) accounts for most of the increase in thyroid cancer in recent decades. We compared clinical outcomes and surgical complications of lobectomy and total thyroidectomy (TT) in PTMC patients. Design and methods In this retrospective individual risk factor-matched cohort study, 2031 patients with PTMC were initially included. Patients who underwent lobectomy or TT were one-to-one matched according to individual risk factors, including age, sex, primary tumor size, extrathyroidal extension, multifocality and cervical lymph node (LN) metastasis. Results In total, 688 patients were assigned to each group. During the median 8.5 years of follow-up, 26 patients (3.8%) in the lobectomy group and 11 patients (1.6%) in the TT group had recurrences. The relative risk of recurrence was significantly less in the TT than that in the lobectomy group (hazard ratio (HR) 0.41; 95% confidence interval (CI) 0.21–0.81; P = 0.01). Most recurrences (84.6%) in the lobectomy group occurred in the contralateral lobe, and all patients were disease-free after completion of thyroidectomy. There were no significant differences in recurrence-free survival between the two groups after exclusion of contralateral lobe recurrences (HR, 2.75; 95% CI, 0.08–8.79; P = 0.08). There were significantly more patients with transient and permanent hypoparathyroidism in the TT than that in the lobectomy group (P < 0.001). Conclusions Lobectomy could be appropriate for most patients with PTMC when there is no evidence of extrathyroidal disease in the preoperative work-up. Preoperative and postoperative imaging studies are important for patients who undergo lobectomy for PTMC, because most recurrences are in the contralateral lobe.


2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Thomas Cochrane ◽  
Rachel Davey ◽  
Christopher Gidlow ◽  
Zafar Iqbal ◽  
Jagdish Kumar ◽  
...  

Background. Few studies have investigated individual risk factor contributions to absolute cardiovascular disease (CVD) risk. Even fewer have examined changes in individual risk factors as components of overall modifiable risk change following a CVD prevention intervention.Design. Longitudinal study of population CVD risk factor changes following a health screening and enhanced support programme.Methods. The contribution of individual risk factors to the estimated absolute CVD risk in a population of high risk patients identified from general practice records was evaluated. Further, the proportion of the modifiable risk attributable to each factor that was removed following one year of enhanced support was estimated.Results. Mean age of patients (533 males, 68 females) was 63.7 (6.4) years. High cholesterol (57%) was most prevalent, followed by smoking (53%) and high blood pressure (26%). Smoking (57%) made the greatest contribution to the modifiable population CVD risk, followed by raised blood pressure (26%) and raised cholesterol (17%). After one year of enhanced support, the modifiable population risk attributed to smoking (56%), high blood pressure (68%), and high cholesterol (53%) was removed.Conclusion. Approximately 59% of the modifiable risk attributable to the combination of high blood pressure, high cholesterol, and current smoking was removed after intervention.


2012 ◽  
Vol 48 (6) ◽  
pp. 348-351 ◽  
Author(s):  
Metin Kaplan ◽  
Hakan Cakin ◽  
Niyazi Ozdemir ◽  
Cuneyt Gocmez ◽  
Sait Ozturk ◽  
...  

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