Loop Electrosurgical Excision of the Cervix and the Subsequent Risk of Preterm Delivery

Abstract

The loop electrosurgical excision procedure (LEEP) is extensively used worldwide as an alternative to cold-knife conization and CO 2 laser treatment of high-grade cervical intraepithelial neoplasia, a precursor of cervical cancer. The LEEP requires less technical skill, causes fewer complications, and takes less time than the other procedures. This study, based on data from a large cohort of Danish women, examined the association, if any, between LEEP and preterm delivery before 37 weeks' gestation. The study population consisted of 11,088 women 20-29 years of age who were first seen in 1991 and were followed up in 1993-1995 and 1999-2000. Of 14,982 deliveries taking place during follow-up, 542 were preterm, taking place at 21-37 weeks' gestation. The incidence of preterm delivery was 3.5% in women not undergoing LEEP and 6.6% in those having the procedure. The increase in risk was statistically significant (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.9). The strongest risk factor was a previous preterm delivery (OR, 2.3; 95% CI, 1.4-3.7). Other risk factors included smoking during pregnancy and low educational status. No clear correlation was evident between preterm delivery and the time since LEEP. The risk of preterm delivery increased by an estimated 20% for each additional millimeter of cone height excised. Preterm deliveries were more frequent in women having LEEP at all gestational ages except 35-36 weeks. This study disclosed a nearly 2-fold increase in the risk of preterm delivery in women with a history of LEEP.