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.

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.

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.

Individual participant data collected during the study will not be made available to other researchers to protect participant confidentiality and comply with institutional privacy regulations.

The independent specialist performing all preoperative and postoperative transvaginal Doppler evaluations was completely blinded to the intraoperative details and surgical modification groups.