{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:11:31Z","timestamp":1789661491859,"version":"4.0.1"},"reference-count":47,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,11,13]],"date-time":"2023-11-13T00:00:00Z","timestamp":1699833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate whether conisation increases chorioamnionitis (CAM) and assess whether this risk differs between preterm and term periods. Furthermore, we estimated mediation effects of CAM between conisation and preterm birth (PTB).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A nationwide observational study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Japan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Singleton pregnant women derived from the perinatal registry database of the Japan Society of Obstetrics and Gynaecology between 2013 and 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The association between a history of conisation and clinical CAM was examined using a multivariable logistic regression model with multiple imputation. We conducted mediation analysis to estimate effects of CAM on PTB following conisation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Clinical CAM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1\u2009500\u2009206 singleton pregnant women, 6961 (0.46%) underwent conisation and 1\u2009493\u2009245 (99.5%) did not. Clinical CAM occurred in 150 (2.2%) and 11\u2009484 (0.8%) women with and without conisation, respectively. Conisation was associated with clinical CAM (odds ratio [OR] 3.09; 95% confidence interval (CI) 2.63\u20133.64; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) (risk difference 1.57%; 95% CI 1.20\u20131.94). The association was detected among 171\u2009440 women with PTB (OR 3.09; 95% CI 2.57\u20133.71), whereas it was not significant among 1\u2009328\u2009284 with term birth (OR 0.88; 95% CI 0.58\u20131.34). OR of total effect of conisation on PTB was 2.71, OR of natural indirect effect (effect explained by clinical CAM) was 1.04, and OR of natural direct effect (effect unexplained by clinical CAM) was 2.61. The proportion mediated was 5.9%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Conisation increased CAM occurrence. Obstetricians should be careful regarding CAM in women with conisation, especially in preterm period. Bacterial infections may be an important cause of PTB after conisation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17718","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T05:09:47Z","timestamp":1699938587000},"page":"977-984","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Uterine cervical conisation and chorioamnionitis: A nationwide observational study"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5986-8726","authenticated-orcid":false,"given":"Yoshimitsu","family":"Wada","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironori","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manabu","family":"Ogoyama","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Horie","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirotada","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rie","family":"Usui","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Chik","family":"Jwa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8861-1572","authenticated-orcid":false,"given":"Akihide","family":"Ohkuchi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,13]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15565"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.03.028"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(80)90556-6"},{"issue":"11","key":"e_1_2_12_5_1","article-title":"Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease","volume":"11","author":"Kyrgiou M","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/0028-2243(94)01986-H"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-005-0727-1"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2006.04.003"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2012.01.019"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i3633"},{"key":"e_1_2_12_11_1","unstructured":"Japan Society of Obstetrics and Gynecology [Internet][cited 2023 May 3]. 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