Pregnancy outcomes after treatment for preinvasive cervical lesions
A partir d'une revue systématique de la littérature publiée entre 1948 et 2016 (71 études, 6 338 982 participantes dont 65 082 traitées), cette méta-analyse évalue les effets des traitements locaux d'une néoplasie cervicale intraépithéliale (conisation, excision, ablation) sur les événements indésirables pendant la grossesse et après la naissance
Ioannis Biliatis, consultant gynaecologist/oncologistPoole NHS Trust, Poole BH15 2JB, UKgiannisbil{at}hotmail.comNew analyses will help women balance the effectiveness of treatment with the safety of future pregnanciesThe anatomy and histological structure of the uterine cervix are mainly responsible for providing the support needed to bring a pregnancy to term. Both characteristics can be significantly altered after surgical excision or ablation for the treatment of preinvasive or early invasive cervical lesions. Despite the documented effectiveness of these treatments1 they can potentially weaken the cervix, leading to preterm birth and all consequent adverse sequelae in the neonate. Young women of reproductive age presenting to the colposcopy clinics with preinvasive cervical lesions pose a challenge for clinicians. The treatment, usually with a cone biopsy, needs to be deep enough to prevent recurrence and provide oncological safety but shallow enough to provide subsequent obstetric safety. For years a debate on the best size and depth of the cone to satisfy both above conditions has left clinicians uncertain how radical they should be.In a linked paper, Kyrgiou and colleagues (doi:10.1136/bmj.i3636) report a comprehensive meta-analysis of 71 studies, including …