ArticleBMJ (Clinical research ed.)2014
Risk of preterm delivery with increasing depth of excision for cervical intraepithelial neoplasia in England: nested case-control study.
Article in BMJ (Clinical research ed.), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 47 papers, 4 of them syntheses that pooled it.
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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.
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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.
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Who cites it
47 citing papers in PubMed, 4 syntheses or guidelines pooled it, 120 citations in OpenAlex.
- Timely follow-up of positive cancer screening results: A systematic review and recommendations from the PROSPR Consortium.CA: a cancer journal for clinicians · 2018Pooled it
- Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease.The Cochrane database of systematic reviews · 2017Pooled it
- Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis.BMJ (Clinical research ed.) · 2016Pooled it
- Fertility and early pregnancy outcomes after conservative treatment for cervical intraepithelial neoplasia.The Cochrane database of systematic reviews · 2015Pooled it
- Comparison of the Roche cobas® 4800 and Digene Hybrid Capture® 2 HPV tests for primary cervical cancer screening in the HPV FOCAL trial.BMC cancer · 2015Trial
- A Comparison of Methods for Modeling Multistate Cancer Progression Using Screening Data with Censoring after Intervention.Medical decision making : an international journal of the Society for Medical Decision Making · 2026Article
- Systematic photodynamic therapy for concurrent cervical-vaginal high-grade squamous intraepithelial lesion: a series of eight cases.Lasers in medical science · 2026Article
- Article
- Impact of large-loop excision of the transformation zone on cervical morphology: A prospective observational study.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Real-world outcomes of photodynamic therapy for HPV-associated lower genital tract lesions: a 2024-2025 gynecology follow-up cohort study.Frontiers in oncology · 2026Article
- HPV negative conversion following Hiporfin PDT for HPV associated HSIL in the female lower reproductive tract.Scientific reports · 2025Article
- Cervical Regeneration Following Monopolar Electrosurgical Conization: A Prospective Evaluation of Volume, Length, and Transformation Zone Reformation.Journal of clinical medicine · 2025Article
- Article
- Efficacy of transabdominal cerclage by open laparotomy relative to existing risk factors.Acta obstetricia et gynecologica Scandinavica · 2025Article
- Cervical intraepithelial neoplasia grade 1 and long-term risk of progression and treatment.PloS one · 2025Article
- How to screen the cervix and reduce the risk of spontaneous preterm birth in asymptomatic women without a prior preterm birth.Obstetrics & gynecology science · 2023Article
- Ultrasound Control of Cervical Regeneration after Large Loop Excision of the Transformation Zone: Results of an Innovative Measurement Technique.Diagnostics (Basel, Switzerland) · 2023Article
- Large Conization-Retrospective Monocentric Results for Fertility Preservation in Young Women with Early Stage Cervical Cancer.Reproductive sciences (Thousand Oaks, Calif.) · 2022Article
- Healing pattern of the cervical stroma following cold coagulation treatment for cervical intraepithelial neoplasia: A case report.Oncology letters · 2022Article
- Article
Corrections and comments
- Commented on by
- Erratum issuedChin, S [corrected to China, S]
Authors and funding
10 authors at 5 institutions in 1 country.
Funding
Abstract
objectiveTo determine the association between depth of excision of cervical intraepithelial neoplasia and risk of preterm birth.
designCase-control study nested in record linkage cohort study.
setting12 hospitals in England.
participantsFrom a cohort of 11 471 women with at least one histological sample taken at colposcopy and a live singleton birth (before or after colposcopy), 1313 women with a preterm birth (20-36 weeks) were identified and frequency matched on maternal age at delivery, parity, and study site to 1313 women with term births (38-42 weeks).
main outcome measuresRisk of preterm birth and very/extreme preterm birth by depth of excisional treatment of the cervical transformation zone.
resultsAfter exclusions, 768 preterm births (cases) and 830 term births after colposcopy remained. The risk of preterm birth was no greater in women with a previous small (<10 mm) excision (absolute risk 7.5%, 95% confidence interval 6.0% to 8.9%) than in women with a diagnostic punch biopsy (7.2%, 5.9% to 8.5%). Women with a medium (10-14 mm) (absolute risk 9.6%; relative risk 1.28, 0.98 to 1.68), large (15-19 mm) (15.3%; 2.04, 1.41 to 2.96), or very large (≥ 20 mm) excision (18.0%; 2.40, 1.53 to 3.75) had a higher risk of preterm delivery than those with small excision. The same pattern was seen in 161 women with very/extremely preterm births (20-31 weeks) and with increasing volume excised. Most births were conceived more than three years after colposcopy, and the risk of preterm delivery did not seem to depend on time from excision to conception.
conclusionsThe risk of preterm birth is at most minimally affected by a small excision. Larger excisions, particularly over 15 mm or 2.66 cm(3), are associated with a doubling of the risk of both preterm and very preterm births. The risk does not decrease with increasing time from excision to conception. Efforts should be made to excise the entire lesion while preserving as much healthy cervical tissue as possible. Close obstetric monitoring is warranted for women who have large excisions of the cervical transformation zone.
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