HPV status after cold knife conization.

INTRODUCTION: The aim of this study was to determine whether HPV DNA test after cold knife conization is a predictive factor for CIN persistence or recurrence. The study also investigated whether HPV DNA test results should influence post cold knife excision surveillance. MATERIALS AND METHODS: A retrospective observation study was performed on 738 patients who underwent cold knife conization for CIN or microinvasive cervical cancer at the University Clinic of Obstetrics & Gynecology, Medical Faculty, Ss. Cyril and Methodius University, Skopje from 1st June 2007 to 1st June 2009. A total of 217 patients met the inclusion criteria and were with complete data. The follow-up HPV DNA testing was performed at 8 months after cold knife conization, after which the patients were followed-up every 4 months till 24 months postoperatively. RESULTS: HPV DNA testing after 8 months after conization showed that 44 patients were HPV DNA positive and 199 were HPV DNA negative. Recurrent cytological abnormalities were found in 26 of the 44 HPV DNA positive patients, and in 12 of the 199 HPV DNA negative patients. Analysis showed that a positive HPV DNA result was a risk factor for recurrent/persistent cervical intraepithelial neoplasia. CONCLUSION: HPV DNA testing 8 months after conization is important for predicting the risk of disease: persistence or recurrence. In addition, such testing can assist in designing patient management, since HPV DNA negative patients should undergo routine surveillance, while HPV DNA positive patients should undergo frequent and meticulous surveillance.

Fetal growth restriction and maternal smoking in the Macedonian Roma population: a causality dilemma.

PURPOSE: Macedonia is one of the top five countries globally in reported smoking rates. Over 10 % of the population consists of the underprivileged Roma minority. We aimed to determine whether Roma ethnicity is an independent risk factor for adverse pregnancy outcome or merely mediating maternal smoking. METHODS: Maternal data were retrieved from the perinatal computerized database for all deliveries during 2007-2011 at the only Clinical Hospital in Bitola, Macedonia. Multivariable regression models were constructed to control for confounders. RESULTS: Of nearly 7,000 deliveries, 8.65 % were of maternal Roma ethnicity and 40 % of the Romani women admitted to regularly smoke during pregnancy. Both Roma ethnicity and maternal smoking were significantly associated with the absence of maternal education, history of abortions and intra uterine growth restriction (IUGR) in the univariate analysis. Both maternal Roma ethnicity (OR 2.46, 95 % CI 1.79-3.38) and smoking status (OR 1.37, 95 % CI 1.02-1.85) were found to be independent predictors of IUGR using the multivariate analysis. Lower birthweight and smaller head circumference were both independently associated with Roma ethnicity and smoking. CONCLUSIONS: Underprivileged ethnic background is a significant risk factor for IUGR, independent of maternal smoking status. To the best of our knowledge, this is the first publication focusing on pregnancy outcome in Romani Macedonian parturients.