The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy-related morbidity

Please cite this paper as: Khalid S, Dimitriou E, Conroy R, Paraskevaidis E, Kyrgiou M, Harrity C, Arbyn M, Prendiville W. The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy‐related morbidity. BJOG 2012;119:685–691. Objective  The aim of this study was to determin...

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Veröffentlicht in:BJOG : an international journal of obstetrics and gynaecology Jg. 119; H. 6; S. 685 - 691
Hauptverfasser: Khalid, S, Dimitriou, E, Conroy, R, Paraskevaidis, E, Kyrgiou, M, Harrity, C, Arbyn, M, Prendiville, W
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Oxford, UK Blackwell Publishing Ltd 01.05.2012
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ISSN:1470-0328, 1471-0528, 1471-0528
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Abstract Please cite this paper as: Khalid S, Dimitriou E, Conroy R, Paraskevaidis E, Kyrgiou M, Harrity C, Arbyn M, Prendiville W. The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy‐related morbidity. BJOG 2012;119:685–691. Objective  The aim of this study was to determine if the individual physical characteristics of the extirpated transformation zone after large loop excision of the transformation zone (LLETZ) might predict the relative risk of adverse obstetric outcome, specifically preterm labour (PTL). Design  A retrospective observational study. Setting  University teaching hospital in Dublin (Coombe Women & Infants University Hospital, CWIUH). Population  Women who had LLETZ treatment for cervical intraepithelial neoplasia (CIN) in the colposcopy service between 1999 and 2002, and who subsequently had a pregnancy at the CWIUH. Methods  Case records and histology reports for eligible women were examined. Age, parity, smoking history, pregnancy complications and CIN grade were recorded. Exclusion criteria were age >42 years, previous treatment for CIN, previous premature labour or twin pregnancies. The Student’s t‐test, Mann–Whitney U‐test, analysis of variants (ANOVA) and logistic regression were employed to analyse the data. Main outcome measures  Gestational age at birth, PTL (i.e. <37 weeks of gestation) and miscarriage rate (<24 weeks of gestation). Results  Out of 1808 women who underwent LLETZ treatment, a total of 353 women were identified who subsequently had a pregnancy at the CWIUH, with 321 being eligible for inclusion in the study. Of these, 76.3% delivered at term, 9.1% delivered at <37 weeks of gestation and 14.6% miscarried at <24 weeks of gestation. There was a three‐fold increase in the risk of PTL if the excision volume exceeded 6 cm3 (RR = 3.00; 95% CI 1.45–5.92), or when the thickness of the excised tissue was greater than 12 mm (RR = 2.98; 95% CI 1.27–7.01). The time interval between LLETZ and pregnancy did not appear to have an effect on PTL rates. We found no association between the grade of CIN and the risk of PTL. Conclusions  This study reveals that the thickness and the total volume of the excised transformation zone are associated with an increased risk of PTL. Excisions thicker than 1.2 cm and larger than 6 cm3 carry a three times greater risk for PTL.
AbstractList Please cite this paper as: Khalid S, Dimitriou E, Conroy R, Paraskevaidis E, Kyrgiou M, Harrity C, Arbyn M, Prendiville W. The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy‐related morbidity. BJOG 2012;119:685–691. Objective  The aim of this study was to determine if the individual physical characteristics of the extirpated transformation zone after large loop excision of the transformation zone (LLETZ) might predict the relative risk of adverse obstetric outcome, specifically preterm labour (PTL). Design  A retrospective observational study. Setting  University teaching hospital in Dublin (Coombe Women & Infants University Hospital, CWIUH). Population  Women who had LLETZ treatment for cervical intraepithelial neoplasia (CIN) in the colposcopy service between 1999 and 2002, and who subsequently had a pregnancy at the CWIUH. Methods  Case records and histology reports for eligible women were examined. Age, parity, smoking history, pregnancy complications and CIN grade were recorded. Exclusion criteria were age >42 years, previous treatment for CIN, previous premature labour or twin pregnancies. The Student’s t ‐test, Mann–Whitney U ‐test, analysis of variants (ANOVA) and logistic regression were employed to analyse the data. Main outcome measures  Gestational age at birth, PTL (i.e. <37 weeks of gestation) and miscarriage rate (<24 weeks of gestation). Results  Out of 1808 women who underwent LLETZ treatment, a total of 353 women were identified who subsequently had a pregnancy at the CWIUH, with 321 being eligible for inclusion in the study. Of these, 76.3% delivered at term, 9.1% delivered at <37 weeks of gestation and 14.6% miscarried at <24 weeks of gestation. There was a three‐fold increase in the risk of PTL if the excision volume exceeded 6 cm 3 (RR = 3.00; 95% CI 1.45–5.92), or when the thickness of the excised tissue was greater than 12 mm (RR = 2.98; 95% CI 1.27–7.01). The time interval between LLETZ and pregnancy did not appear to have an effect on PTL rates. We found no association between the grade of CIN and the risk of PTL. Conclusions  This study reveals that the thickness and the total volume of the excised transformation zone are associated with an increased risk of PTL. Excisions thicker than 1.2 cm and larger than 6 cm 3 carry a three times greater risk for PTL.
The aim of this study was to determine if the individual physical characteristics of the extirpated transformation zone after large loop excision of the transformation zone (LLETZ) might predict the relative risk of adverse obstetric outcome, specifically preterm labour (PTL). A retrospective observational study. University teaching hospital in Dublin (Coombe Women & Infants University Hospital, CWIUH). Women who had LLETZ treatment for cervical intraepithelial neoplasia (CIN) in the colposcopy service between 1999 and 2002, and who subsequently had a pregnancy at the CWIUH. Case records and histology reports for eligible women were examined. Age, parity, smoking history, pregnancy complications and CIN grade were recorded. Exclusion criteria were age >42 years, previous treatment for CIN, previous premature labour or twin pregnancies. The Student's t-test, Mann-Whitney U-test, analysis of variants (ANOVA) and logistic regression were employed to analyse the data. Gestational age at birth, PTL (i.e. <37 weeks of gestation) and miscarriage rate (<24 weeks of gestation). Out of 1808 women who underwent LLETZ treatment, a total of 353 women were identified who subsequently had a pregnancy at the CWIUH, with 321 being eligible for inclusion in the study. Of these, 76.3% delivered at term, 9.1% delivered at <37 weeks of gestation and 14.6% miscarried at <24 weeks of gestation. There was a three-fold increase in the risk of PTL if the excision volume exceeded 6 cm(3) (RR = 3.00; 95% CI 1.45-5.92), or when the thickness of the excised tissue was greater than 12 mm (RR = 2.98; 95% CI 1.27-7.01). The time interval between LLETZ and pregnancy did not appear to have an effect on PTL rates. We found no association between the grade of CIN and the risk of PTL. This study reveals that the thickness and the total volume of the excised transformation zone are associated with an increased risk of PTL. Excisions thicker than 1.2 cm and larger than 6 cm(3) carry a three times greater risk for PTL.
Please cite this paper as: Khalid S, Dimitriou E, Conroy R, Paraskevaidis E, Kyrgiou M, Harrity C, Arbyn M, Prendiville W. The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy‐related morbidity. BJOG 2012;119:685–691. Objective  The aim of this study was to determine if the individual physical characteristics of the extirpated transformation zone after large loop excision of the transformation zone (LLETZ) might predict the relative risk of adverse obstetric outcome, specifically preterm labour (PTL). Design  A retrospective observational study. Setting  University teaching hospital in Dublin (Coombe Women & Infants University Hospital, CWIUH). Population  Women who had LLETZ treatment for cervical intraepithelial neoplasia (CIN) in the colposcopy service between 1999 and 2002, and who subsequently had a pregnancy at the CWIUH. Methods  Case records and histology reports for eligible women were examined. Age, parity, smoking history, pregnancy complications and CIN grade were recorded. Exclusion criteria were age >42 years, previous treatment for CIN, previous premature labour or twin pregnancies. The Student’s t‐test, Mann–Whitney U‐test, analysis of variants (ANOVA) and logistic regression were employed to analyse the data. Main outcome measures  Gestational age at birth, PTL (i.e. <37 weeks of gestation) and miscarriage rate (<24 weeks of gestation). Results  Out of 1808 women who underwent LLETZ treatment, a total of 353 women were identified who subsequently had a pregnancy at the CWIUH, with 321 being eligible for inclusion in the study. Of these, 76.3% delivered at term, 9.1% delivered at <37 weeks of gestation and 14.6% miscarried at <24 weeks of gestation. There was a three‐fold increase in the risk of PTL if the excision volume exceeded 6 cm3 (RR = 3.00; 95% CI 1.45–5.92), or when the thickness of the excised tissue was greater than 12 mm (RR = 2.98; 95% CI 1.27–7.01). The time interval between LLETZ and pregnancy did not appear to have an effect on PTL rates. We found no association between the grade of CIN and the risk of PTL. Conclusions  This study reveals that the thickness and the total volume of the excised transformation zone are associated with an increased risk of PTL. Excisions thicker than 1.2 cm and larger than 6 cm3 carry a three times greater risk for PTL.
Objective: The aim of this study was to determine if the individual physical characteristics of the extirpated transformation zone after large loop excision of the transformation zone (LLETZ) might predict the relative risk of adverse obstetric outcome, specifically preterm labor (PTL). Design: A retrospective observational study. Setting: University teaching hospital in Dublin (Coombe Women & Infants University Hospital, CWIUH). Population: Women who had LLETZ treatment for cervical intraepithelial neoplasia (CIN) in the colposcopy service between 1999 and 2002, and who subsequently had a pregnancy at the CWIUH. Methods: Case records and histology reports for eligible women were examined. Age, parity, smoking history, pregnancy complications and CIN grade were recorded. Exclusion criteria were age >42years, previous treatment for CIN, previous premature labor or twin pregnancies. The Student's t-test, Mann-Whitney U-test, analysis of variants (ANOVA) and logistic regression were employed to analyze the data. Main outcome measures: Gestational age at birth, PTL (i.e. <37weeks of gestation) and miscarriage rate (<24weeks of gestation). Results: Out of 1808 women who underwent LLETZ treatment, a total of 353 women were identified who subsequently had a pregnancy at the CWIUH, with 321 being eligible for inclusion in the study. Of these, 76.3% delivered at term, 9.1% delivered at <37weeks of gestation and 14.6% miscarried at <24weeks of gestation. There was a three-fold increase in the risk of PTL if the excision volume exceeded 6cm3 (RR=3.00; 95%CI 1.45-5.92), or when the thickness of the excised tissue was greater than 12mm (RR=2.98; 95%CI 1.27-7.01). The time interval between LLETZ and pregnancy did not appear to have an effect on PTL rates. We found no association between the grade of CIN and the risk of PTL. Conclusions: This study reveals that the thickness and the total volume of the excised transformation zone are associated with an increased risk of PTL. Excisions thicker than 1.2cm and larger than 6cm3 carry a three times greater risk for PTL. [PUBLICATION ABSTRACT]
The aim of this study was to determine if the individual physical characteristics of the extirpated transformation zone after large loop excision of the transformation zone (LLETZ) might predict the relative risk of adverse obstetric outcome, specifically preterm labour (PTL).OBJECTIVEThe aim of this study was to determine if the individual physical characteristics of the extirpated transformation zone after large loop excision of the transformation zone (LLETZ) might predict the relative risk of adverse obstetric outcome, specifically preterm labour (PTL).A retrospective observational study.DESIGNA retrospective observational study.University teaching hospital in Dublin (Coombe Women & Infants University Hospital, CWIUH).SETTINGUniversity teaching hospital in Dublin (Coombe Women & Infants University Hospital, CWIUH).Women who had LLETZ treatment for cervical intraepithelial neoplasia (CIN) in the colposcopy service between 1999 and 2002, and who subsequently had a pregnancy at the CWIUH.POPULATIONWomen who had LLETZ treatment for cervical intraepithelial neoplasia (CIN) in the colposcopy service between 1999 and 2002, and who subsequently had a pregnancy at the CWIUH.Case records and histology reports for eligible women were examined. Age, parity, smoking history, pregnancy complications and CIN grade were recorded. Exclusion criteria were age >42 years, previous treatment for CIN, previous premature labour or twin pregnancies. The Student's t-test, Mann-Whitney U-test, analysis of variants (ANOVA) and logistic regression were employed to analyse the data.METHODSCase records and histology reports for eligible women were examined. Age, parity, smoking history, pregnancy complications and CIN grade were recorded. Exclusion criteria were age >42 years, previous treatment for CIN, previous premature labour or twin pregnancies. The Student's t-test, Mann-Whitney U-test, analysis of variants (ANOVA) and logistic regression were employed to analyse the data.Gestational age at birth, PTL (i.e. <37 weeks of gestation) and miscarriage rate (<24 weeks of gestation).MAIN OUTCOME MEASURESGestational age at birth, PTL (i.e. <37 weeks of gestation) and miscarriage rate (<24 weeks of gestation).Out of 1808 women who underwent LLETZ treatment, a total of 353 women were identified who subsequently had a pregnancy at the CWIUH, with 321 being eligible for inclusion in the study. Of these, 76.3% delivered at term, 9.1% delivered at <37 weeks of gestation and 14.6% miscarried at <24 weeks of gestation. There was a three-fold increase in the risk of PTL if the excision volume exceeded 6 cm(3) (RR = 3.00; 95% CI 1.45-5.92), or when the thickness of the excised tissue was greater than 12 mm (RR = 2.98; 95% CI 1.27-7.01). The time interval between LLETZ and pregnancy did not appear to have an effect on PTL rates. We found no association between the grade of CIN and the risk of PTL.RESULTSOut of 1808 women who underwent LLETZ treatment, a total of 353 women were identified who subsequently had a pregnancy at the CWIUH, with 321 being eligible for inclusion in the study. Of these, 76.3% delivered at term, 9.1% delivered at <37 weeks of gestation and 14.6% miscarried at <24 weeks of gestation. There was a three-fold increase in the risk of PTL if the excision volume exceeded 6 cm(3) (RR = 3.00; 95% CI 1.45-5.92), or when the thickness of the excised tissue was greater than 12 mm (RR = 2.98; 95% CI 1.27-7.01). The time interval between LLETZ and pregnancy did not appear to have an effect on PTL rates. We found no association between the grade of CIN and the risk of PTL.This study reveals that the thickness and the total volume of the excised transformation zone are associated with an increased risk of PTL. Excisions thicker than 1.2 cm and larger than 6 cm(3) carry a three times greater risk for PTL.CONCLUSIONSThis study reveals that the thickness and the total volume of the excised transformation zone are associated with an increased risk of PTL. Excisions thicker than 1.2 cm and larger than 6 cm(3) carry a three times greater risk for PTL.
Author Dimitriou, E
Conroy, R
Harrity, C
Khalid, S
Paraskevaidis, E
Prendiville, W
Arbyn, M
Kyrgiou, M
Author_xml – sequence: 1
  givenname: S
  surname: Khalid
  fullname: Khalid, S
  organization: RCSI Department of Gynaecology, Coombe Women & Infants University Hospital, Dublin, Ireland
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  givenname: E
  surname: Dimitriou
  fullname: Dimitriou, E
  organization: RCSI Department of Gynaecology, Coombe Women & Infants University Hospital, Dublin, Ireland
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  givenname: R
  surname: Conroy
  fullname: Conroy, R
  organization: Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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  givenname: E
  surname: Paraskevaidis
  fullname: Paraskevaidis, E
  organization: University Hospital of Ioannina, Ioannina, Greece
– sequence: 5
  givenname: M
  surname: Kyrgiou
  fullname: Kyrgiou, M
  organization: Department of Gynaecologic Oncology - Obstetrics & Gynaecology, Queen Charlotte's & Chelsea - Hammersmith Hospital, London, UK
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  surname: Harrity
  fullname: Harrity, C
  organization: RCSI Department of Gynaecology, Coombe Women & Infants University Hospital, Dublin, Ireland
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  surname: Arbyn
  fullname: Arbyn, M
  organization: Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
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  givenname: W
  surname: Prendiville
  fullname: Prendiville, W
  organization: RCSI Department of Gynaecology, Coombe Women & Infants University Hospital, Dublin, Ireland
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ContentType Journal Article
Copyright 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG
2015 INIST-CNRS
2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.
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Issue 6
Keywords Thickness
Pregnancy
Prognosis
Volume
Gynecology
Risk factor
Predictive factor
Obstetrics
Morbidity
Language English
License CC BY 4.0
2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.
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References Prendiville W, De Camargo M, Walker P. The use and abuse of LLETZ. CME J Gynecol Oncol 2000;5:85-7.
Raio L, Ghezzi F, Di Naro E, Gomez R, Luscher KP. Duration of pregnancy after carbon dioxide conization of the cervix: influence of cone height. Obstet Gynecol 1997;90:978-82.
Himes KP, Simhan HN. Time from cervical conization to pregnancy and preterm birth. Obstet Gynecol 2007;6:314-19.
Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet 2006;367:489-98.
Bruinsma F, Quinn M. The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis. BJOG 2011;118:1031-41.
Noehr B, Jensen A, Frederiksen K, Tabor A, Kjaer S. Depth of cervical cone removed by loop electrosurgical excision procedure and subsequent risk of spontaneous preterm delivery. Obstet Gynecol 2009;114:1232-8.
Prendiville W, Cullimore J, Norman S. Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia. Br J Obstet Gynaecol 1989;96:1054-60.
Arbyn M, Kyrgiou M, Simoens C, Raifu AO, Koliopoulos G, Martin-Hirsch P, et al. Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ 2008;337:a1284; Doi: 10.1136/bmj.a1284 (Epub ahead of print).
Sadler L, Saftlas A, Wang W, Exeter M, Whittaker J, McCowan L. Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA 2004;291:2100-6.
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– reference: Bruinsma F, Quinn M. The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis. BJOG 2011;118:1031-41.
– reference: Noehr B, Jensen A, Frederiksen K, Tabor A, Kjaer S. Depth of cervical cone removed by loop electrosurgical excision procedure and subsequent risk of spontaneous preterm delivery. Obstet Gynecol 2009;114:1232-8.
– reference: Raio L, Ghezzi F, Di Naro E, Gomez R, Luscher KP. Duration of pregnancy after carbon dioxide conization of the cervix: influence of cone height. Obstet Gynecol 1997;90:978-82.
– reference: Sadler L, Saftlas A, Wang W, Exeter M, Whittaker J, McCowan L. Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA 2004;291:2100-6.
– reference: Himes KP, Simhan HN. Time from cervical conization to pregnancy and preterm birth. Obstet Gynecol 2007;6:314-19.
– reference: Arbyn M, Kyrgiou M, Simoens C, Raifu AO, Koliopoulos G, Martin-Hirsch P, et al. Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ 2008;337:a1284; Doi: 10.1136/bmj.a1284 (Epub ahead of print).
– reference: Prendiville W, Cullimore J, Norman S. Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia. Br J Obstet Gynaecol 1989;96:1054-60.
– reference: Prendiville W, De Camargo M, Walker P. The use and abuse of LLETZ. CME J Gynecol Oncol 2000;5:85-7.
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  start-page: 978
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  end-page: 82
  article-title: Duration of pregnancy after carbon dioxide conization of the cervix: influence of cone height
  publication-title: Obstet Gynecol
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  start-page: 1054
  year: 1989
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  article-title: Large loop excision of the transformation zone (LLETZ). A new method of management for women with cervical intraepithelial neoplasia
  publication-title: Br J Obstet Gynaecol
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  publication-title: CME J Gynecol Oncol
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  article-title: The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta‐analysis
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  article-title: Treatment for cervical intraepithelial neoplasia and risk of preterm delivery
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  article-title: Depth of cervical cone removed by loop electrosurgical excision procedure and subsequent risk of spontaneous preterm delivery
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  article-title: Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta‐analysis
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  doi: 10.1111/j.1471-0528.2011.02944.x
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  doi: 10.1097/01.AOG.0000251497.55065.74
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  doi: 10.1016/S0140-6736(06)68181-6
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  doi: 10.1097/AOG.0b013e3181bf1ef2
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Snippet Please cite this paper as: Khalid S, Dimitriou E, Conroy R, Paraskevaidis E, Kyrgiou M, Harrity C, Arbyn M, Prendiville W. The thickness and volume of LLETZ...
Please cite this paper as: Khalid S, Dimitriou E, Conroy R, Paraskevaidis E, Kyrgiou M, Harrity C, Arbyn M, Prendiville W. The thickness and volume of LLETZ...
The aim of this study was to determine if the individual physical characteristics of the extirpated transformation zone after large loop excision of the...
Objective: The aim of this study was to determine if the individual physical characteristics of the extirpated transformation zone after large loop excision of...
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SubjectTerms Abortion, Spontaneous - epidemiology
Biological and medical sciences
Cervical intraepithelial neoplasia
Cervical Intraepithelial Neoplasia - pathology
Cervical Intraepithelial Neoplasia - surgery
Cervix Uteri - diagnostic imaging
Cervix Uteri - pathology
Cervix Uteri - surgery
dimensions
electrosurgical excision
Female
Gynecologic Surgical Procedures - adverse effects
Gynecologic Surgical Procedures - methods
Gynecology. Andrology. Obstetrics
Humans
Ireland - epidemiology
large loop excision of the transformation zone
loop electrosurgical excision procedure
Medical disorders
Medical sciences
Morbidity
Obstetric Labor, Premature - epidemiology
Pregnancy
Pregnancy Outcome
pregnancy outcomes
Premature birth
preterm labour
Reproductive system
Retrospective Studies
Risk Factors
Surgical techniques
Ultrasonography
Uterine Cervical Neoplasms - pathology
Uterine Cervical Neoplasms - surgery
Title The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy-related morbidity
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