Pregnancy outcomes after treatment for cervical intraepithelial neoplasia in a single NHS hospital.

OBJECTIVE: The objective of this study was to assess the adverse pregnancy outcomes in women who had treatment for cervical intraepithelial neoplasia. METHODS: This was a retrospective cohort using data linkage. Pathology databases from Whipps Cross University Hospital were used to identify women with a histological sample taken at colposcopy between 1995 and 2009. Births for these women were identified through the hospitals' obstetric database. A total of 876 births (from 721 women) were identified. Logistic regression was used to assess the relationship between adverse pregnancy outcomes and treatment for cervical intraepithelial neoplasia before delivery. Results were adjusted by ethnicity, deprivation, and parity. RESULTS: After taking into account parity, socioeconomic status, and ethnicity, receiving any type of excisional treatment (single or multiple) before birth increased the risk of preterm labor compared with having a punch biopsy only (adjusted relative risk, 1.61; 95% confidence interval, 1.11-2.32). Preterm deliveries that occurred after a spontaneous onset of labor were found to be more likely after treatment for cervical disease (adjusted relative risk, 1.68; 95% confidence interval, 1.11-2.52). CONCLUSIONS: Women receiving any type of excisional treatment before delivery are at increased risk of preterm delivery when compared with women attending colposcopy but not treated. Although we took into account the effects of parity, socioeconomic status, and ethnicity, residual confounding factors may be unidentified.

Costs of maternal conditions attributable to smoking during pregnancy.

CONTEXT: Despite known adverse health effects, many women continue to smoke during pregnancy. Public attention has now focused on the economic as well as health effects of this behavior. OBJECTIVE: To estimate health care costs associated with smoking-attributable cases of placenta previa, abruptio placenta, ectopic pregnancy, preterm premature rupture of the membrane (PPROM), pre-eclampsia, and spontaneous abortion. DESIGN: Pooled odds ratios were used with data on total cases to estimate smoking-attributable cases. Estimated average costs for cases of ectopic pregnancy and spontaneous abortion were used to estimate smoking-attributable health care costs for these conditions. Incremental costs, or costs above those for a "normal" delivery, were used to estimate smoking-attributable costs of placenta previa, abruptio placenta, PPROM, and pre-eclampsia associated with delivery. SETTING: National estimates for 1993. PARTICIPANTS: Data from the National Hospital Discharge Survey (NHDS) and claims data from a sample of large, self-insured employers across the country. RESULTS: Smoking-attributable costs ranged from $1.3 million for PPROM to $86 million for ectopic pregnancy. Smoking during pregnancy apparently protects against pre-eclampsia and saves between $36 and $49 million, depending on smoking prevalence. Over all conditions smoking-attributable costs ranged from $135 to $167 million. CONCLUSIONS: Smoking during pregnancy is a preventable cause of higher health care costs for the conditions studied. While smoking during pregnancy was found to be protective against pre-eclampsia and, hence, saves costs, the net costs were still positive and significant. Effective smoking-cessation programs can reduce health care costs but clinicians will perhaps need to manage increased cases of pre-eclampsia in a cost-effective manner.

Pregnancy outcome after expectant management of premature rupture of the membranes in the second trimester.

Because management of premature rupture of the membranes (PROM) at or before 26 weeks is controversial, we examined maternal and perinatal outcome after expectant management of 44 pregnancies complicated by this problem. Mean gestational age at preterm PROM was 23.9 +/- 1.7 (SD) weeks. The latency period between preterm PROM and delivery ranged from 1 to 68 days, with a medium of 6. Of the patients, 54.6% delivered within a week of PROM, and 79.5% delivered by four weeks; 77.2% developed chorioamnionitis, but despite this high incidence, there was no maternal sepsis or pelvic thrombophlebitis, and no maternal surgery was necessary. Perinatal outcome was 60.5% neonatal survival, 54.2% perinatal survival and a stillbirth rate of 10.4%. Respiratory distress syndrome, bronchopulmonary dysplasia, sepsis and intraventricular hemorrhage were common types of neonatal morbidity. There was no pulmonary hypoplasia, and limb deformity was seen in only two neonates. Costs of expectant management in pregnancies complicated by second-trimester PROM were estimated, and a strategy to reduce cost is suggested.