Comparative fertility and pregnancy outcomes after local treatment for cervical intraepithelial neoplasia and stage 1a1 cervical cancer: protocol for a systematic review and network meta-analysis from the CIRCLE group.
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BORIS DOI
Publisher DOI
PubMed ID
31636110
Description
INTRODUCTION
There are several local treatment methods for cervical intraepithelial neoplasia that remove or ablate a cone-shaped part of the uterine cervix. There is evidence to suggest that these increase the risk of preterm birth (PTB) and that this is higher for techniques that remove larger parts of the cervix, although the data are conflicting. We present a protocol for a systematic review and network meta-analysis (NMA) that will update the evidence and compare all treatments in terms of fertility and pregnancy complications.
METHODS AND ANALYSIS
We will search electronic databases (CENTRAL, MEDLINE, EMBASE) from inception till October 2019, in order to identify randomised controlled trials (RCTs) and cohort studies comparing the fertility and pregnancy outcomes among different excisional and ablative treatment techniques and/or to untreated controls. The primary outcome will be PTB (<37 weeks). Secondary outcomes will include severe or extreme PTB, prelabour rupture of membranes, low birth weight (<2500 g), neonatal intensive care unit admission, perinatal mortality, total pregnancy rates, first and second trimester miscarriage. We will search for published and unpublished studies in electronic databases, trial registries and we will hand-search references of published papers. We will assess the risk of bias in RCTs and cohort studies using tools developed by the Cochrane collaboration. Two investigators will independently assess the eligibility, abstract the data and assess the risk of bias of the identified studies. For each outcome, we will perform a meta-analysis for each treatment comparison and an NMA once the transitivity assumption holds, using the OR for dichotomous data. We will use CINeMA (Confidence in Network meta-analysis) to assess the quality of the evidence for the primary outcome.
ETHICS AND DISSEMINATION
Ethical approval is not required. Results will be disseminated to academic beneficiaries, medical practitioners, patients and the public.
PROSPERO REGISTRATION NUMBER
CRD42018115495.
There are several local treatment methods for cervical intraepithelial neoplasia that remove or ablate a cone-shaped part of the uterine cervix. There is evidence to suggest that these increase the risk of preterm birth (PTB) and that this is higher for techniques that remove larger parts of the cervix, although the data are conflicting. We present a protocol for a systematic review and network meta-analysis (NMA) that will update the evidence and compare all treatments in terms of fertility and pregnancy complications.
METHODS AND ANALYSIS
We will search electronic databases (CENTRAL, MEDLINE, EMBASE) from inception till October 2019, in order to identify randomised controlled trials (RCTs) and cohort studies comparing the fertility and pregnancy outcomes among different excisional and ablative treatment techniques and/or to untreated controls. The primary outcome will be PTB (<37 weeks). Secondary outcomes will include severe or extreme PTB, prelabour rupture of membranes, low birth weight (<2500 g), neonatal intensive care unit admission, perinatal mortality, total pregnancy rates, first and second trimester miscarriage. We will search for published and unpublished studies in electronic databases, trial registries and we will hand-search references of published papers. We will assess the risk of bias in RCTs and cohort studies using tools developed by the Cochrane collaboration. Two investigators will independently assess the eligibility, abstract the data and assess the risk of bias of the identified studies. For each outcome, we will perform a meta-analysis for each treatment comparison and an NMA once the transitivity assumption holds, using the OR for dichotomous data. We will use CINeMA (Confidence in Network meta-analysis) to assess the quality of the evidence for the primary outcome.
ETHICS AND DISSEMINATION
Ethical approval is not required. Results will be disseminated to academic beneficiaries, medical practitioners, patients and the public.
PROSPERO REGISTRATION NUMBER
CRD42018115495.
Date of Publication
2019-10-21
Publication Type
Article
Keyword(s)
"Ablation Techniques "Cervical Intraepithelial Neoplasia "Conization "Pregnancy "Premature Birth"[Mesh] adverse effects"[Mesh] complications"[Mesh] surgery"[Mesh] therapy"[Mesh]
Language(s)
en
Contributor(s)
Athanasiou, Antonios | |
Veroniki, Areti Angeliki | |
Kalliala, Ilkka | |
Naci, Huseyin | |
Bowden, Sarah | |
Paraskevaidi, Maria | |
Martin-Hirsch, Pierre | |
Bennett, Philip | |
Paraskevaidis, Evangelos | |
Kyrgiou, Maria |
Additional Credits
Series
BMJ open
Publisher
BMJ Publishing Group
ISSN
2044-6055
Access(Rights)
open.access