ABSTRACT
OBJECTIVES: Evaluate the obstetrical outcomes in the case of women with a history of conization. Determine the role of the cone length in the obstetrical issue. MATERIALS AND METHODS: Retrospective case-control study including the patients (n=39) who had undergone a conization in a university hospital between January 2002 and January 2012. The obstetrical outcomes have been compared to those from a control group (n=78). Into the exposed group the obstetrical outcomes has been compared based on the cone length. RESULTS: Thirty-one patients delivered after a conization (39 deliveries). The obstetrical outcomes have been significantly increased in the exposed group: preterm delivery before 37 weeks gestation (25.6% vs 7.7%, P=0.01), before 32 weeks gestation (15.4% vs 1.3%, P=0.005) and between 28 weeks gestation (10.2% vs 0%, P=0.01), premature onset of labor before 32 weeks gestation (12.8% vs 1.3%, P=0.01) and before 28 weeks gestation (12.8% vs 0%, P=0.01) and preterm premature rupture of membranes before 37 weeks gestation (20.5% vs 1.3%, P<0.001). There was no significant difference for a length cone more than 1.5cm. CONCLUSION: Our study showed that a history of conization is an obstetrical risk factor to consider in the management of a subsequent pregnancy.
Subject(s)
Conization , Pregnancy Outcome/epidemiology , Uterine Cervical Dysplasia/surgery , Uterine Cervical Neoplasms/surgery , Adult , Birth Weight/physiology , Case-Control Studies , Conization/adverse effects , Conization/statistics & numerical data , Female , Fetal Membranes, Premature Rupture/epidemiology , Fetal Membranes, Premature Rupture/etiology , Humans , Infant, Newborn , Obstetric Labor, Premature/epidemiology , Obstetric Labor, Premature/etiology , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/etiology , Premature Birth/epidemiology , Premature Birth/etiology , Retrospective Studies , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/rehabilitation , Young Adult , Uterine Cervical Dysplasia/epidemiology , Uterine Cervical Dysplasia/rehabilitationABSTRACT
Cytology remains the mainstay for cervical screening. The need to achieve effective management, limit complications, and preserve reproductive function led to the popularity of local treatment. Although the cure rates for ablative and excisional methods are similar, the excisional method provides a more reliable histopathological diagnosis. Recent evidence revealed increased perinatal morbidity after treatment that appears to be related to the proportion of cervix removed. The human papillomavirus (HPV) DNA test appears to enhance the detection of disease in primary screening, in the triage of minor cytological abnormalities, and in follow-up. Further research on the clinical application of a scoring system is ongoing. The vaccines are now available and appear to be safe, well tolerated, and highly efficacious in HPV naive women. A synergy of vaccination and screening will be required. Treatment for early cervical cancer is increasingly shifting toward more fertility-sparing surgical techniques. Careful selection of patients is essential.
Subject(s)
Alphapapillomavirus/physiology , Genital Diseases, Female/etiology , Genital Diseases, Female/therapy , Papillomavirus Infections/therapy , Algorithms , Cytodiagnosis/methods , Female , Genital Diseases, Female/rehabilitation , Humans , Mass Screening/methods , Papillomavirus Infections/etiology , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/rehabilitation , Uterine Cervical Neoplasms/therapy , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Dysplasia/rehabilitation , Uterine Cervical Dysplasia/therapyABSTRACT
When oncology evolved into a specialized field of medicine more than four decades ago, the primary goals of most cancer treatment included the extension of patients' life expectancies and the occasional hope for cure. Physicians were seen as the principal and solitary advocate for patients, and information regarding cancer diagnosis, treatment, and side effects was delivered or screened by a doctor. Patient education materials were scarce, formalized support systems were nonexistent, and the future was often difficult to define. Patient advocacy has since expanded to models of self, organizational, and public policy advocacy. This article provides examples of advocacy organizations and support systems that offer guidance to providers and patients throughout the continuum of cancer care and into longer-term survival.
Subject(s)
Patient Advocacy , Self-Help Groups , Survivors , Uterine Cervical Dysplasia/rehabilitation , Humans , Internet , Patient Education as Topic/methods , Social SupportABSTRACT
El estudio presenta tres años de experiencia en el uso de la radiocirugía (LEEP en el tratamiento de la neoplasia intraepitelial cervical (N.I.C) en el centro de la patología cervical y colposcopia de la empresa social del estado (E.S.E.) Metrosalud. Los resultados muestran las ventajas y desventajas del método en un reporte comparativo con conización hecha con bisturí frío. El LEEP permitió una mejor valorización reduciendo el diagnóstico principalmente en las pacientes con diagnóstico colpo-histológico de NIC II (37.5 por ciento), sin embargo se incrementó el porcentaje de compromiso de los bordes de resección (18.4 por ciento vs 4.8 por ciento), el cual disminuyó al lograr mayor experiencia con el método (5.8 por ciento). Se discute el manejo de los conos y LEEP con bordes comprometidos y la necesidad de un segundo procedimiento terapéutico ante la alta probabilidad de lesión residual (Cono frío = 66.7 por ciento y LEEP = 83.3 por ciento). Finalmente, se propone marginar la conización con bisturí frío a los procedimientos diagnósticos en que esté indicado en vista de su costo y morbilidad, y dejar de usarlo como procedimiento terapéutico reemplazándolo por la radiocirugía. En el futuro inmediato la radiocirugía permitirá también reducir el número de histerectomías por NIC
