Abstract
Objective
To estimate the incidence and outcomes of cervical intraepithelial neoplasia (CIN) and cervical cancer in pregnancy.
Methods
We conducted a population-based cohort study using the United States Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from 1999 to 2008. The incidence of CIN and cervical cancer was measured and logistic regression analysis used to estimate the adjusted effect of CIN and cervical cancer on obstetrical outcomes.
Results
There were 8,826,137 births over a 10-year period of which 11,755 were among women with CIN and 294 among women with cervical cancer. Compared with controls, women with CIN were younger, had lower annual incomes, and more likely to be on Medicaid while women with cancer were more likely to be older. Women with CIN had lower rates of cesarean delivery but higher rates of transfusions and cesarean hysterectomies, while women with cancer had higher rates of cesarean deliveries, transfusions and cesarean hysterectomies. There were no significant increase of thrombosis; maternal death, instrumental delivery, IUGR, PPROM or intrauterine death was found.
Conclusion
CIN and cervical cancer are rare in pregnancy. Although there is a greater risk of transfusion/hysterectomy, overall major maternal and neonatal morbidity does not appear to be increased.
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References
Creasman WT (2001) Cancer and pregnancy. Ann NY Acad Sci 943:281–286
Fader AN, Alward EK, Niederhauser A et al (2010) Cervical dysplasia in pregnancy: a multi-institutional evaluation. Am J Obstet Gynecol 203(113):e1–e6
Oduncu F, Kimmig R, Hepp H, Emmerich B (2003) Cancer in pregnancy: maternal-fetal conflict. J Cancer Res Clin Oncol 129:133–146
Van der Vange N, Weverling G, Ketting B, Ankum W, Samlal R, Lammes F (1995) The prognosis of cervical cancer associated with pregnancy: a matched cohort study. Obstet Gynecol 85:1022–1026
Pereg D, Koren G, Lishner M (2008) Cancer in pregnancy: gaps, challenges and solutions. Cancer Treat Rev 34:302–312
Palle C, Bangsbøll S, Andreasson B (2000) Cervical intraepithelial neoplasia in pregnancy. Acta Obstet Gynecol Scand 79:306–310
Hacker NF, Berek JS, Lagasse LD, Charles EH, Savage EW, Moore JG (1982) Carcinoma of the cervix associated with pregnancy. Obstet Gynecol 59:735
Williams TJ, Brack CB (1964) Carcinoma of the cervix in pregnancy. Cancer 17:1486–1491
Abitbol MM, Benjamin F, Gastillo N (1973) Management of the abnormal cervical smear and carcinoma in situ of the cervix during pregnancy. Am J Obstet Gynecol 117:904–908
Woodrow N, Permezel M, Butter field L, Rome R, Tan J, Quinn M (1998) Abnormal cervical cytology in pregnancy: experience of 811 cases. Aust N Z J Obstet Gynaecol 38:161–165
Cuschieri K, Cubie H, Whitley M et al (2005) Persistent high risk HPV infection associated with development of cervical neoplasia in a prospective population study. J Clin Pathol 58:946
Dalrymple JL, Gilbert WM, Leiserowitz GS et al (2005) Pregnancy-associated cervical cancer: obstetric outcomes. J Matern Fetal and Neonatal Med 17:269–276
Roetzheim RG, Pal N, Tennant C et al (1999) Effects of health insurance and race on early detection of cancer. J Natl Cancer Inst 91:1409
Zemlickis D, Lishner M, Degendorfer P, Panzarella T, Sutcliffe SB, Koren G (1991) Maternal and fetal outcome after invasive cervical cancer in pregnancy. J Clin Oncol 9:1956
van Vliet W, van Loon AJ, ten Hoor KA, Boonstra H (1998) Cervical carcinoma during pregnancy: outcome of planned delay in treatment. Eur J Obst Gynecol Reprod Biol 79:153–157
Sood AK, Sorosky JI, Krogman S, Anderson B, Benda J, Buller RE (1996) Surgical management of cervical cancer complicating pregnancy: a case-control study. Gynecol Oncol 63:294–298
Germann N, Haie-Meder C, Morice P et al (2005) Management and clinical outcomes of pregnant patients with invasive cervical cancer. Ann Oncol 16:397
Lee RB, Neglia MAJW, Park RC (1981) Cervical carcinoma in pregnancy. Obstet Gynecol 58:584
Van Calsteren K, Heyns L, De Smet F et al (2010) Cancer during pregnancy: an analysis of 215 patients emphasizing the obstetrical and the neonatal outcomes. J Clin Oncol 28:683
Jakobsson M, Gissler M, Sainio S, Paavonen J, Tapper AM (2007) Preterm delivery after surgical treatment for cervical intraepithelial neoplasia. Obstet Gynecol 109:309
Arbyn M, Kyrgiou M, Simoens C et al (2008) Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ British Med J 337:a1284
Shanbhag S, Clark H, Timmaraju V, Bhattacharya S, Cruickshank M (2009) Pregnancy outcome after treatment for cervical intraepithelial neoplasia. Obstet Gynecol 114:727
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Al-Halal, H., Kezouh, A. & Abenhaim, H.A. Incidence and obstetrical outcomes of cervical intraepithelial neoplasia and cervical cancer in pregnancy. Arch Gynecol Obstet 287, 245–250 (2013). https://doi.org/10.1007/s00404-012-2475-3
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DOI: https://doi.org/10.1007/s00404-012-2475-3