TITLE:
Adverse Pregnancy Outcomes Following Cryotherapy, Thermal Ablation and Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia Treatment: A Pilot Study among Zambian Women
AUTHORS:
Victoria Mwiinga-Kalusopa, Johanna E. Maree, Concepta Kwaleyela, Patricia Katowa-Mukwato
KEYWORDS:
Adverse Pregnancy Outcomes, Cervical Intraepithelial Neoplasia, Cryothera-py, Thermal Ablation, Loop Electrosurgical Excision Procedure, Pilot, Repro-ductive Age
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.14 No.1,
January
10,
2024
ABSTRACT: Background: Cervical Intraepithelial neoplasia treatments have become essential
interventions to manage cervical lesions. Majority of the recipients of these treatments are
women within the reproductive age group, who according to literature may be at risk of adverse
pregnancy outcomes. This pilot study is part
of a study investigating adverse pregnancy outcomes
among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical
Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443
treated and n = 443 untreated) women aged 15 - 49 years. The women were
either screened with Visual Inspection with Acetic Acid or treated for Cervical
Intraepithelial neoplasia at the Adult Infectious Disease Centre between
January 2010 and December 2020. Women meeting the criteria were identified
using the Visual Inspection with Acetic Acid screening records and telephone
interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA
version 16 to determine the prevalence and obtain frequency distribution of
outcomes of interest. Univariate and multivariable binary logistic regression
estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were
observed to be more prevalent in the treatment group (18.5%) compared to the
untreated group (5.4%). Normal pregnancy outcomes
were lower in the treated (46.3%; n = 443) than the untreated (53.7%; n = 443).
The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority
of still births (72.7%). Women treated
with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision
Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003) had two-, six- and ten-times
higher odds of adverse pregnancy outcomes respectively, relative to women who
required no treatment. Conclusion: Adverse pregnancy outcomes are prevalent among women who have received treatment in Zambia. The findings indicate that treating Cervical
Intraepithelial Neoplasia has been linked to higher chances of experiencing
abortion, delivering low birth weight babies and enduring prolonged labor that
may result in a caesarean section delivery. Cervical neoplasia treatments,
particularly Loop Electrosurgical Excision Procedure, are associated with significantly increased odds of
adverse pregnancy outcomes. It is essential to include information about prior Cervical Intraepithelial neoplasia treatment outcomes in
obstetric care.