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Loop electrosurgical excision procedure and the risk for preterm delivery.

Annu Heinonen¹, Mika Gissler, Annika Riska

¹Department of Obstetrics and Gynecology, Helsinki University Central Hospital, and the National Institute of Health and Welfare, Helsinki, Finland; and the Nordic School of Public Health, Gothenburg, Sweden.

Obstetrics and Gynecology

|May 3, 2013

Summary

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Loop electrosurgical excision procedure (LEEP) increases preterm delivery risk. Repeat LEEP significantly elevates this risk, underscoring the need to avoid it in women of reproductive age.

Area of Science:

Gynecology
Obstetrics
Reproductive Health

Background:

Cervical intraepithelial neoplasia (CIN) is a precursor to cervical cancer.
Loop electrosurgical excision procedure (LEEP) is a common treatment for CIN.
Previous studies suggest a potential link between LEEP and adverse pregnancy outcomes.

Purpose of the Study:

To determine if CIN severity and LEEP influence preterm delivery risk.
To evaluate the impact of repeat LEEP and the time interval since LEEP on preterm delivery.

Main Methods:

Retrospective register-based study in Finland (1997-2009).
Linked hospital discharge and birth register data for 20,011 women post-LEEP and 430,975 controls.
Main outcome: preterm delivery before 37 weeks gestation.

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Main Results:

LEEP was associated with a 61% increased risk of preterm delivery (OR 1.61).
Repeat LEEP showed a nearly threefold increased risk (OR 2.80).
Increased risk observed for LEEP due to carcinoma in situ, microinvasive cancer, and non-CIN lesions.

Conclusions:

LEEP increases preterm delivery risk irrespective of histopathologic diagnosis.
Repeat LEEP poses the highest risk and should be avoided in women of reproductive age.