Effects of cervical excisional procedures for cervical intraepithelial neoplasia on pregnancy and birth: A literature review

Abstract

A Corresponding Author: rebecca@ osbornehay.co.nz B Liggins Institute, The University of Auckland; Warkworth Birthing Centre; self-employed midwife C Otago Polytechnic, Dunedin Background: Anecdotal evidence suggests midwives recognise that pregnancy and birth may be affected by cervical scarring caused by excisional procedures in the treatment of cervical intraepithelial neoplasia (CIN2 and 3). Affected women seeking information about the effect on their pregnancy and labour must rely on the knowledge of maternity care providers or take guidance from consumer publications. A literature review was undertaken with the objective of exploring pregnancy and birth outcomes following cervical excisional procedures. Method: CINAHL, ProQuest, Pubmed, Google Scholar and Cochrane databases were searched for full text, peer-reviewed articles discussing either original research or systematic reviews, published from 2001-2016. Inclusion criteria were applied and comparative analysis was used to identify and compare outcomes. Findings: Seventeen articles were included for review. Fifteen articles discuss the relationship of cervical excisional procedures to an increased incidence of preterm birth. Other outcomes include the increased incidence of preterm, pre-labour rupture of membranes, or consideration of associated low birthweight related to the method or depth of excision. No articles were found which considered the provision of intrapartum care to women with a history of cervical excision procedures. Conclusion: Current research regarding the effect of cervical excision procedure history on pregnancy and birth is largely limited to quantifying the incidence of preterm birth and preterm, pre-labour rupture of membranes, or in discussing the impact of the method and depth of excision. Research to identify, describe, or best clinically manage the experience of birthing at term with cervical scarring appears to be absent. Further research is needed to extend midwifery knowledge regarding the provision of care during pregnancy and labour to affected women at term.