• G Ortoft, Tb Henriksen, Es Hansen, and Lk Petersen.
• Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark. Ortoft@dadlnet.dk
• BJOG. 2010 Feb 1;117(3):258-67.

ObjectiveTo determine the effects of one or two conisations on preterm delivery and perinatal mortality in subsequent pregnancies.DesignA population-based cohort study.SettingAarhus University Hospital.PopulationPreterm delivery and mortality rates were evaluated in 721 deliveries after one conisation, and in 37 deliveries after two conisations, and were compared with 390 deliveries after dysplasia and 74 552 deliveries that were not preceded by conisation or dysplasia.MethodsCox regression was used to evaluate preterm delivery rates and perinatal mortality.Main Outcome MeasuresBirthweight, gestational age (prior to 28, 32, and 37 weeks of gestation, respectively) and perinatal mortality.ResultsThe risk of preterm delivery was increased after one conisation [adjusted hazard ratios (95% CI): <37 weeks, 2.8 (2.3-3.5); <28 weeks, 4.9 (2.5-9.7)], and was further increased after two conisations [adjusted hazard ratios (95% CI): <37 weeks, 9.9 (6-17); <28 weeks, 9.8 (1.4-70)], compared with no conisation. One conisation was associated with an increased perinatal mortality [<28 weeks, 9.9 (4.0-25)]. All three methods of conisation [large loop excision of the transformation zone, electroknife and cold knife] increased the risk of preterm delivery.ConclusionsA single conisation was associated with a 2.8-fold increased risk of perinatal death, most likely because of a 4.9-fold increase in extreme preterm delivery. Only 37 patients had two conisations, and the results showed a ten-fold increase in the risk of preterm delivery.

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