Loop Electrosurgical Excision Procedure and the Risk for Preterm Delivery

Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki, Uusimaa, Finland
Obstetrics and Gynecology (Impact Factor: 5.18). 05/2013; 121(5):1063-8. DOI: 10.1097/AOG.0b013e31828caa31
Source: PubMed


: To estimate whether the severity of cervical intraepithelial neoplasia (CIN) and the loop electrosurgical excision procedure (LEEP) increase the risk for preterm delivery, and to evaluate the role of repeat LEEP and time interval since LEEP.
: This was a retrospective register-based study from Finland from 1997 to 2009. We linked Hospital Discharge Register and Finnish Medical Birth Register data. Case group women consisted of 20,011 women who underwent LEEP during the study period and their subsequent singleton deliveries in 1998-2009. Control population included women from the Medical Birth Register with no LEEP (n=430,975). The main outcome measure was preterm delivery before 37 weeks of gestation.
: The risk for preterm delivery increased after LEEP. Women with previous LEEP had 547 (7.2%) preterm deliveries, whereas the control population had 30,151 (4.6%) preterm deliveries (odds ratio [OR] 1.61, confidence interval [CI] 1.47-1.75, number needed to harm 38.5). The overall preterm delivery rate in the study period was 4.6% for singleton deliveries. Repeat LEEP was associated with an almost threefold risk for preterm delivery (OR 2.80, CI 2.28-3.44). The severity of CIN did not increase the risk for preterm delivery. However, with LEEP for carcinoma in situ or microinvasive cancer, the risk for preterm delivery was higher (OR 2.55, CI 1.68-3.87). The increased risk also was associated with non-CIN lesions (OR 2.04, CI 1.46-2.87). Similarly, the risk was increased after diagnostic LEEP (OR 1.39, 95% CI 1.16-1.67). Time interval since LEEP was not associated with preterm delivery. Adjusting for maternal age, parity, socioeconomic or marital status, urbanism, and previous preterm deliveries did not change the results.
: The risk for preterm delivery was increased after LEEP regardless of the histopathologic diagnosis. The risk was highest after repeat LEEP, which should be avoided, especially among women of reproductive age.
: II.

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    • "The analysis of the correlation between the risk for preterm delivery and the time elapsed from LEEP to the subsequent pregnancy showed that women with a time interval of up to 12 months and a limited length of cone excised do not have an increased risk for preterm delivery compared with those who became pregnant after 12 months. The findings of this study were not unexpected and confirm previous rigorously carried out studies by Khalid et al. (2012), Conner et al. (2013) and Heinonen et al. (2013), who did not find any correlation between the time interval from LEEP to pregnancy and the risk for preterm delivery. However, there is not much literature on the importance of the time interval between LEEP and pregnancy in relation to the risk for preterm delivery, and other studies reported an increased risk for preterm birth with a shorter interval from LEEP to pregnancy. "
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    ABSTRACT: Previous studies have shown mixed results for pregnancy outcomes after loop electrosurgical excision procedure (LEEP); however, evidence is lacking regarding the pregnancy outcome of spontaneous abortion with respect to time elapsed from LEEP to pregnancy. We investigated risks of spontaneous abortion and preterm birth as they relate to time elapsed from LEEP to pregnancy. A 10-year, multicenter cohort study of women who underwent LEEP was performed between 1996 and 2006. Trained research nurses conducted telephone interviews with all patients to complete data extraction unavailable in charts. Median time from LEEP to pregnancy for spontaneous abortion compared with no spontaneous abortion and preterm birth before 34 and before 37 weeks of gestation compared with term birth were estimated. Patients with time intervals less than 12 months compared with 12 months or more from LEEP to pregnancy were then compared with identify adjusted odds ratios for spontaneous abortion and preterm birth. Five hundred ninety-six patients met inclusion criteria. Median time from LEEP to pregnancy was significantly shorter for women with a spontaneous abortion (20 months [interquartile range 11.2-40.9] compared with 31 months [interquartile range 18.7-51.2]; P=.01) but did not differ for women with a term birth compared with preterm birth. Women with a time interval less than 12 months compared with 12 months or more were at significantly increased risk for spontaneous abortion (17.9% compared with 4.6%; adjusted odds ratio 5.6; 95% confidence interval 2.5-12.7). No increased risk was identified for preterm birth before 34 weeks of gestation or before 37 weeks of gestation. Women with a shorter time interval from LEEP to pregnancy are at increased risk for spontaneous abortion but not preterm birth. LEVEL OF EVIDENCE:: II.
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