The Proportion of Excised Cone Volume for Cervical Lesions is the Best Predictor of Pregnancy Outcomes after Cervical Conization

Abstract Background: As much more women in the reproductive period are treated with a cervical conization, the risk of subsequent adverse pregnancy outcomes is also increasing. We carried the present study to evaluate whether absolute cone length/volume and the proportions of the cone length/volume correlate to spontaneous abortion (SAB) and spontaneous preterm birth (SPTB) and their predictive values.Methods: The present retrospective observational study included 312 women undergoing cervical conization for cervical lesions at the Affiliated Hospital of Qingdao University during 2012–2019. The information about the pretreatment cervical dimensions and cone size and pregnancy outcomes were collected to assess the correlation between cone parameters and pregnancy outcomes.Results: In the multivariate logistic regression models, the cervical length excised, the cervical volume excised, the proportion of the length excised, and the proportion of the cervical volume excised significantly correlated with SAB and SPTB, respectively (P<0.05). A most significant inverse correlation of the proportion of the cervical volume excised with pregnancy duration emerged (P<0.001, r=-0.220). The area under the curve (AUC) of the proportion of the cervical volume excised was greatest (0.700,95% CI 0.634-0.765). And the risk of SAB and SPTB increased with the proportion of the cervical volume excised increasing (OR 19.704, 95% CI 4.646-83.568). The cutoff point of the proportion of the cervical volume excised was 19.5% (sensitivity 0.635; specificity 0.655). Conclusion: The cone length/volume and the proportions of cervical length/volume excised were associated with increased risks of SAB and SPTB. The proportion of the cervical volume excised is the best predictor for SAB and SPTB after cervical conization. When the proportion of the cervical volume excised is more than 19.5%, women should be informed about their future risk of SAB and SPTB after cervical conization for cervical lesions.