Which treatment for cervical lesions optimizes pregnancy outcomes?

It seems laser conization is associated with a slightly lower risk of adverse pregnancy outcomes than cold knife conization or large loop excision of the transformation zone (LLETZ), and laser ablation entails the lowest risk of all-findings that could prove very important to the many women of reproductive age receiving treatment for intraepithelial or early invasive cervical lesions.

In a recent review and meta-analysis of 27 published studies, researchers found that cold knife conization was significantly associated with delivery at less than 37 weeks (RR 2.59), birthweight less than 2,500 g (RR 2.53), and cesarean section (RR 3.17). Similarly, LLETZ was significantly associated with the first two conditions and premature rupture of membranes (RR 1.70, 1.82, and 2.69, respectively).

Laser conization was marginally and non-significantly associated with only preterm delivery (RR 1.71), and laser ablation wasn't significantly associated with an increased risk for any of the obstetric outcomes reviewed. However, the analysis revealed statistically nonsignificant adverse trends for neonatal ICU admission and perinatal mortality.