Cervical excisional treatment increases the risk of intra-amniotic infection in subsequent pregnancy complicated by preterm prelabor rupture of membranes.

• Excisional treatment of cervical intraepithelial neoplasia or very early stages of cervical cancer increases the risk of preterm prelabor rupture of membranes (PPROM) in subsequent pregnancies. The risk increases with the length of the excised cone. The subset of PPROM with a history of cervical excisional treatment could also be jeopardized by a higher risk intra-amniotic infection/inflammation . However, there is a paucity of relevant information on this field.To assess the differences in the rates of intra-amniotic infection/inflammation and early-onset neonatal sepsis between singleton PPROM pregnancies without and with a history of cervical excisional treatment and to identify an association between these complications of PPROM and the excised cone length.This retrospective cohort study included 770 PPROM pregnancies in whom transabdominal amniocentesis was performed as part of standard clinical management to determine intra-amniotic environment. The maternal and perinatal medical records of all included women were reviewed to obtain information on the absence or presence of a history of cervical excisional treatment and neonatal outcomes. Women whose records contained any information on a history of cervical excisional treatment were contacted by phone and in writing to inform them of the study and request permission to collect relevant information from their medical records. Women were divided into four subgroups according to the presence of microorganisms and/or their nucleic acids (through culturing and molecular biology method) in amniotic fluid and/or intra-amniotic inflammation (through amniotic fluid interleukin-6 concentration evaluation): intra-amniotic infection (presence of both), sterile intra-amniotic inflammation (intra-amniotic inflammation alone), microbial invasion of the amniotic cavity without inflammation (the presence of microorganisms and/or their nucleic acids in amniotic fluid alone), and negative amniotic fluid for infection/inflammation (absence of both).A history of cervical excisional treatment was found in 10% (76/765) of the women. Of these, 82% (62/76) had a history of only one treatment, and information on the cone length was available for 97% (60/62) of them. Women with a history of cervical excisional treatment had higher rates of intra-amniotic infection [with: 25% (19/76) vs. without: 12% (85/689), adj. OR: 2.5, adj. p = 0.004], microbial invasion of the amniotic cavity without inflammation [with: 25% (19/76) vs. without: 11% (74/689), adj. OR: 3.1, adj. p < 0.0001], and early-onset neonatal sepsis [with: 8% (11/76) vs. without: 3% (23/689), adj. OR: 2.9, adj. p = 0.02] than those without cervical excisional treatment. Quartiles of the cone length (range: 3-32 mm) were used to categorize the women into four quartile subgroups (1st quartile: 3-8 mm; 2nd quartile: 9-12 mm; 3rd quartile: 13-17 mm, and 4th quartile: 18-32 mm). Cone length of ≥ 18 mm was associated with higher rates of intra-amniotic infection [with: 29% (5/15) vs. without: 12% (85/689), adj. OR: 3.0, adjusted p = 0.05], microbial invasion of the amniotic cavity without inflammation [with: 40% (6/15) vs. without: 11% (74/689), adj. OR: 6.1, adj. p = 0.003), and early-onset neonatal sepsis [with: 20% (3/15) vs. without: 3% (23/689), adj. OR: 5.7, adj. p = 0.02].History of cervical excisional treatment increases risks of intra-amniotic infection, microbial invasion of the amniotic cavity without inflammation, and development of early-onset neonatal sepsis in a subsequent pregnancy complicated by preterm prelabor rupture of membranes.

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MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)

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