Cervical Intraepithelial Neoplasia, Uterine Artery Hemodynamics
Conditions
Keywords
Cervical conization, Uterine artery Doppler, Resistance index, Vascular resistance, Pregnancy complications
Brief summary
The objective of this prospective study is to evaluate the hemodynamic impact of cervical conization on uterine artery blood flow by focusing on the Resistance Index (RI) as a direct indicator of distal vascular resistance. The central hypothesis is predicated on the physiological principle that the surgical excision and subsequent sealing of terminal cervical branches during conization increases the distal vascular impedance (afterload) encountered by the main uterine artery. Uterine artery Doppler RI measurements are performed preoperatively and at one month postoperatively to assess these alterations.
Detailed description
Eligible patients undergoing cervical conization are evaluated using transvaginal color Doppler sonography to examine alterations in bilateral uterine artery blood flow. Sonographic examinations are standardized and conducted during the follicular phase of the menstrual cycle, both preoperatively and at the one-month postoperative follow-up visit. Participant allocation to surgical modification groups is determined through a randomization process, where patients receive either hemostatic lateral sutures placed at the 3 and 9 o'clock positions of the cervix or undergo the procedure without any lateral sutures. Fresh pathology specimens are systematically weighed and measured for volume. Postoperative changes in the right and left uterine artery Resistance Index (Delta RI) are analyzed to determine the independent effects of surgical techniques, specimen physical dimensions, and histopathological lesion severity on uterine hemodynamics.
Interventions
PROCEDURECervical Conization
Surgical excision of a symmetric cervical cone specimen surrounding the endocervical canal. The procedure is executed under general anesthesia using electrocautery via the Covidien Forcetriad energy platform with restricted power levels (Coagulation: 40 W, Cutting: 40 W) to minimize secondary thermal tissue damage.
Sponsors
Adana City Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
SINGLE (Outcomes Assessor)
Masking description
The independent specialist performing all preoperative and postoperative transvaginal Doppler evaluations was completely blinded to the intraoperative details and surgical modification groups.
Intervention model description
A randomized parallel group design evaluating patients who undergo cervical conization either with or without the placement of hemostatic sutures at the 3 and 9 o'clock positions.
Eligibility
Sex/Gender
FEMALE
Age
30 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
1. Regularly menstruating female patients aged between 30 and 50 years. 2. Definitive clinical indication for cervical conization based on abnormal cervical cytology, positive HPV screening, or colposcopy-guided biopsy findings.
Exclusion criteria
1. Concomitant pelvic pathologies that could independently alter uterine artery blood flow or Doppler indices, such as uterine fibroids, ovarian cysts, endometriosis, pelvic inflammatory disease (PID), or hydrosalpinx. 2. Acute postoperative bleeding complications.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Uterine Artery Resistance Index (RI) | Preoperatively and at 1 month postoperatively | Evaluation of bilateral uterine artery Doppler Resistance Index (RI) waveforms to measure modifications in downstream distal vascular resistance following microvascular occlusion. |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORGorkem Ulger, M.D.
Niğde Training and Research Hospital
Outcome results
None listed