Evidence map›Paper›PMID 18801868›Full record

SynthesisBMJ (Clinical research ed.)2008

Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis.

M Arbyn, M Kyrgiou, C Simoens, A O Raifu, G Koliopoulos, P Martin-Hirsch, W Prendiville, E Paraskevaidis

Registry-linked trialOpen access · hybridAbstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03233412 (Ensaio clínico Randomizado Avaliando a eficácia do Tratamento tópico Com Imiquimode em lesões Intraepiteliais Cervicais de Alto Grau), which is not on this map. Cited by 209 papers, 24 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
209citing papers in PubMed, 24 pooled it
31.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03233412 phase2completednot on this mapstarted 2018, after this paper: background citation

Ensaio clínico Randomizado Avaliando a eficácia do Tratamento tópico Com Imiquimode em lesões Intraepiteliais Cervicais de Alto Grau

TypeinterventionalSponsorBarretos Cancer HospitalRan2018 to 2020Enrolled90ConditionsHigh Grade Intraepithelial Neoplasia, Cervix CancerArmsControl, Imiquimod
3 · Its place in the literature

Who cites it

209 citing papers in PubMed, 24 syntheses or guidelines pooled it, 696 citations in OpenAlex.

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  18. Recommendations on screening for cervical cancer.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2013
    Guideline
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149 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 5 countries.

M ArbynScientific Institute of Public Health, Brussels, Belgium. Marc.Arbyn@iph.fgov.be
M Kyrgiou
C Simoens
A O Raifu
G Koliopoulos
P Martin-Hirsch
W Prendiville
E Paraskevaidis
Institut Scientifique de Santé Publique · BELancashire Teaching Hospitals NHS Foundation Trust · GBUniversity Hospital of Ioannina · GRCoombe Women & Infants University Hospital · IE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo assess the relative risk of perinatal mortality, severe preterm delivery, and low birth weight associated with previous treatment for precursors of cervical cancer. DATA SOURCES: Medline and Embase citation tracking from January 1960 to December 2007. Selection criteria Eligible studies had data on severe pregnancy outcomes for women with and without previous treatment for cervical intraepithelial neoplasia. Considered outcomes were perinatal mortality, severe preterm delivery (<32/34 weeks), extreme preterm delivery (<28/30 weeks), and low birth weight (<2000 g, <1500 g, and <1000 g). Excisional and ablative treatment procedures were distinguished.

resultsOne prospective cohort and 19 retrospective studies were retrieved. Cold knife conisation was associated with a significantly increased risk of perinatal mortality (relative risk 2.87, 95% confidence interval 1.42 to 5.81) and a significantly higher risk of severe preterm delivery (2.78, 1.72 to 4.51), extreme preterm delivery (5.33, 1.63 to 17.40), and low birth weight of <2000 g (2.86, 1.37 to 5.97). Laser conisation, described in only one study, was also followed by a significantly increased chance of low birth weight of <2000 g and <1500 g. Large loop excision of the transformation zone and ablative treatment with cryotherapy or laser were not associated with a significantly increased risk of serious adverse pregnancy outcomes. Ablation by radical diathermy was associated with a significantly higher frequency of perinatal mortality, severe and extreme preterm delivery, and low birth weight below 2000 g or 1500 g.

conclusionsIn the treatment of cervical intraepithelial neoplasia, cold knife conisation and probably both laser conisation and radical diathermy are associated with an increased risk of subsequent perinatal mortality and other serious pregnancy outcomes, unlike laser ablation and cryotherapy. Large loop excision of the transformation zone cannot be considered as completely free of adverse outcomes.

Indexed as

FemaleHumansInfant, Low Birth WeightInfant, NewbornObstetric Labor, PrematureObstetric Surgical ProceduresPerinatal MortalityPregnancyPregnancy Complications, NeoplasticPregnancy OutcomeRisk FactorsUterine Cervical DysplasiaUterine Cervical Neoplasms

Identifiers

PMID18801868
PMCPMC2544379
OpenAlexW2073934456

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.