February 2005 CCC Corner > Abstract of the Month

Abstract(s) of the Month

LEEP Treatment Increases Risk of Preterm Delivery in Future Pregnancies

OBJECTIVE: To estimate whether the loop electrosurgical excision procedure (LEEP) is associated with an adverse effect on the outcome of subsequent pregnancies. 

METHODS: A retrospective cohort study was performed. The study group comprised women who had a LEEP in Halifax County between 1992 and 1999 and then had a subsequent singleton pregnancy of greater than 20 weeks of gestation with delivery at the IWK Health Centre in Halifax, Nova Scotia. The comparison group comprised women with no history of cervical surgery who were matched for age, parity, smoking status, and year of delivery. There were 571 women in each group. The primary outcome was rate of preterm delivery at less than 37 weeks of gestation. Secondary outcomes included delivery at less than 34 weeks and various neonatal and maternal outcomes. The effect of specific LEEP characteristics was analyzed separately.

RESULTS: Women who had a LEEP were more likely to deliver preterm overall (7.9% versus 2.5%; odds ratio [OR] 3.50, 95% confidence interval [CI] 1.90-6.95; P < .001) and to deliver preterm after premature rupture of membranes (PROM) (3.5% versus 0.9%; OR 4.10, 95% CI 1.48-14.09). The increase in delivery at less than 34 weeks was not statistically significant (1.25% versus 0.36%; OR 3.50, 95% CI 0.85-23.49; P = .12). Women with LEEP also delivered more low birth weight (LBW) infants (5.4% versus 1.9%; OR 3.00, 95% CI 1.52-6.46; P = .003). There were no differences in other neonatal or maternal outcomes. No association was found between the characteristics of the LEEP, including depth, and the rate of preterm delivery. 

CONCLUSION: Loop electrosurgical excision procedure is associated with an increased risk of overall preterm delivery, preterm delivery after PROM, and LBW infants in subsequent pregnancies at greater than 20 weeks of gestation. Women who are considering future pregnancies should be counseled about these risks during informed consent for LEEP. 

LEVEL OF EVIDENCE: II-2.

Samson SL et al The effect of loop electrosurgical excision procedure on future pregnancy outcome.Obstet Gynecol. 2005 Feb;105(2):325-32.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15684160

OB/GYN CCC Editorial comment:

The above study further develops the literature base that supports that LEEP is associated with adverse outcomes related to premature delivery on subsequent pregnancies. See also the CCC Corner 9/04 comments, re: Sadler 2004.

Patients should be counseled about these risks and providers should fully outline alternative therapies, which may include careful observation in many cases. The potential risks of LEEP on future pregnancies is one more reason that low-grade CIN should followed closely for a period of time instead of being immediately treated since most low-grade CIN will spontaneously regress and will not need treatment (ASCCP). If current therapy is deemed necessary, then cryotherapy is often a reasonable alternative. njm

Other resources:

ACOG: LEEP Treatment Increases Risk of Preterm Delivery in Future Pregnancies

https://www.acog.com/from_home/publications/press_releases/nr01-31-05-2.cfm

CCC Corner 9/04 comments, re: Sadler 2004

http://www.ihs.gov/MedicalPrograms/MCH/M/OBGYN0904_HT.cfm#ob

Sadler L, et al Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA. 2004 May 5;291(17):2100-6. 

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15126438

Clinical uses of human papillomavirus (HPV) DNA Self Assessment Booklet: ASCCP

http://www.asccp.org/bookstore.shtml#

http://www.asccp.org/edu/hpv_testing.shtml

Back to top

OB/GYN

Dr. Neil Murphy is the Obstetrics and Gynecology Chief Clinical Consultant (OB/GYN C.C.C.). Dr. Murphy is very interested in establishing a dialogue and/or networking with anyone involved in women's health or maternal child health, especially as it applies to Native or indigenous peoples around the world. Please don't hesitate to contact him by e-mail or phone at 907-729-3154.