History Of Loop Electrosurgical Excision Procedure Research Articles

Midtrimester cervical elastography in pregnant women with a history of loop electrosurgical excision procedure (LEEP)

We aimed to compare cervical elastographic parameters based on a previous loop electrosurgical excision procedure (LEEP) and to determine whether they can predict preterm delivery in pregnant women with a history of LEEP. This multicenter prospective case–control study included 71 singleton pregnant women at 14–24 weeks of gestation with a history of LEEP and 1:2 gestational age-matched controls. We performed cervical elastography using E-cervix and compared maternal characteristics, delivery outcomes, cervical length (CL), and elastographic parameters between the two groups. The median mid-trimester CL was significantly shorter in the LEEP group. Most elastographic parameters, including internal os (IOS), external os (EOS), elasticity contrast index (ECI), and hardness ratio (HR), were significantly different in the two groups. In the LEEP group, the sPTD group compared to the term delivery (TD) group showed a higher rate of previous sPTD (50% vs. 1.7%, p < 0.001), higher IOS and ECI (IOS: 0.28 [0.12–0.37] vs. 0.19 [0.10–0.37], p = 0.029; ECI: 3.89 [1.79–4.86] vs. 2.73 [1.48–5.43], p = 0.019), and lower HR (59.97 [43.88–92.43] vs. 79.06 [36.87–95.40], p = 0.028), but there was no significant difference in CL (2.92 [2.16–3.76] vs. 3.13 [1.50–3.16], p = 0.247). In conclusion, we demonstrated that a history of LEEP was associated with a change in cervical strain measured in mid-trimester as well as with CL shortening. We also showed that cervical elastography can be useful in predicting sPTD in pregnant women with previous LEEP.

Preterm birth after loop electrosurgical excision procedure (LEEP): how cone features and microbiota could influence the pregnancy outcome.

In the last years, the mean age of women who underwent cervical treatment for high-grade cervical intraepithelial neoplasia (CIN 2-3) is similar to the age of women having their first pregnancy. The aim of this study was to evaluate the risk of preterm birth in subsequent pregnancies after loop electrosurgical excision procedure (LEEP). From January 2013 to January 2016 the study identified a total of 1435 women, nulliparous, who underwent LEEP for CIN 2-3, and who wished to have their first pregnancy. Before surgery, the lengths of the cervix were calculated by transvaginal sonography. After the treatment, the dimension of the removed tissue was evaluated. During the pregnancy, all women carried out periodic transvaginal sonography and vaginal-cervical swabs. The average age of patients was 31.96±5.24 years; the interval between the surgical procedure and pregnancy was 12.04±4.67 months; the gestational age at births was 37.53±2.91 weeks. The first vaginal and cervical swab performed during pregnancy was negative in 81.8% of patients. The most prevalent infections were related to C. Albicans, G. Vaginalis, and Group B Streptococcus (GBS). The rate of preterm delivery was significantly higher in women with a minor cervical length. The length and the volume of cervical tissue excised have been shown to be directly related to the risk for preterm birth. Furthermore, vaginal infections and their persistence during pregnancy in women with a history of LEEP may be associated with an increased risk for preterm birth, compared with women with no history of LEEP.

Loop Electrosurgical Excision Procedure and Risk for Preterm Birth

In the United States, ∼12% of all neonates are born preterm. Prior excisional procedures to diagnose and treat cervical dysplasia are a risk factor of preterm delivery. Studies on the risk for preterm birth in women after cold knife conization, laser cone, or loop electrosurgical excision procedure (LEEP) have provided conflicting results. One consideration is whether the increased risk for preterm birth is attributable to the cervical excision procedure itself or secondary to risk factors associated with cervical dysplasia. This review was performed to assess whether LEEP increases the risk for preterm birth before 37 weeks’ gestation and to clarify whether the increased risk for preterm birth is attributable to the procedure or to risk factors associated with cervical dysplasia. The review and meta-analysis were based on a predesigned protocol; PubMed, EMBASE, SCOPUS, CENTRAL, and ClinicalTrials.gov databases were searched. The review included cohort and case-control studies that compared rates of preterm birth in women with prior LEEP and women with no history of cervical excision. The primary outcome was preterm birth at less than 37 weeks. Secondary outcomes were preterm birth at less than 34 weeks, spontaneous preterm birth, preterm premature rupture of membranes, and perinatal mortality. The exposure was a history of LEEP for treatment of cervical dysplasia. Two unexposed categories included women with no or unknown history of cervical dysplasia and women with a history of cervical dysplasia but no excisional procedure. Data were analyzed using Stata 12.0 with METAN software. From 559 publications, 47 studies were examined; the final analysis included 16 retrospective cohort and 2 prospective cohort studies and 1 case-control study. These reports comprised 6589 patients with a history of LEEP (exposed) and 1,415,015 without a history of LEEP (unexposed). All studies reported preterm birth at less than 37 weeks’ gestation as an outcome. Loop electrosurgical excision procedure was associated with a higher risk for preterm birth at less than 37 weeks (8.8% vs 5.1%; pooled relative risk (RR) 1.61; 95% confidence interval [CI], 1.35–1.92; P = 0.001). No statistically significant difference was found in the risk for preterm birth when the prior LEEP group was compared with women with a history of cervical dysplasia but no excision procedure (4 studies: 10.0% vs 7.2%; pooled RR, 1.08; 95% CI, 0.88–1.33; P = 0.654). The association between LEEP and preterm birth persisted when the comparison group was women with either no history or unknown history of dysplasia (15 studies: 8.6% vs 4.6%; pooled RR, 1.86; 95% CI, 1.58–2.21; P = 0.69). In 8 studies, spontaneous preterm birth at less than 37 weeks could specifically be assessed. Although a similar magnitude of increase in risk was found, it was not statistically significant (8 studies: 6.8% vs 3.4%; pooled RR, 1.60; 95% CI, 0.99–2.55). The risk for preterm premature rupture of membranes was increased greater than 2-fold in women with a history of LEEP (6 studies: 5.1% vs 2.5%; pooled RR, 2.37; 95% CI, 1.64–3.44), as was the risk for preterm birth at less than 34 weeks (5 studies: 2.9% vs 2.3%; pooled RR, 2.21; 95% CI, 1.33–3.67). The perinatal mortality risk was elevated in women with a prior LEEP but was not statistically significant (1.0% vs0.8%; pooled RR, 1.63; 95% CI, 0.95–2.80; P = 0.911). Women with a prior LEEP are at increased risk for preterm birth before 37 weeks, but the risk was not significantly different when compared with women with prior dysplasia but no cervical excision. Risk factors of dysplasia and preterm birth are shared, and LEEP itself may not be an independent risk factor of preterm birth. If LEEP is not an independent risk factor of preterm birth, the risk and benefits of LEEP or expectant management might be altered, thus ensuring optimal therapy without fear of increasing the risk for preterm birth.

Loop electrosurgical excision procedure and risk of preterm birth: a systematic review and meta-analysis.

To assess whether loop electrosurgical excision procedure (LEEP) increases the risk for preterm birth before 37 weeks of gestation and clarify whether the increased risk for preterm birth is attributable to the procedure itself or to risk factors associated with cervical dysplasia. Two authors performed a search of the relevant data through February 2013 using PubMed, Embase, Scopus, CENTRAL, and ClinicalTrials.gov. We included observational studies that compared rates of preterm birth in women with prior LEEP with women with no history of cervical excision. Nineteen of 559 identified studies met selection criteria. We compared women with a history of LEEP with two unexposed groups without a history of cervical excision: 1) women with an unknown or no history of cervical dysplasia; and 2) women with a history of cervical dysplasia but no cervical excision. The primary outcome was preterm birth before 37 weeks of gestation. Secondary outcomes were preterm birth before 34 weeks of gestation, spontaneous preterm birth, preterm premature rupture of membranes, and perinatal mortality. DerSimonian-Laird random effects models were used. We assessed heterogeneity between studies using the Q and I tests. Stratified analyses and metaregression were performed to assess confounding. Nineteen studies were included with a total of 6,589 patients with a history of LEEP and 1,415,015 without. Overall, LEEP was associated with an increased risk of preterm birth before 37 weeks of gestation (pooled relative risk 1.61, 95% confidence interval [CI] 1.35-1.92). However, no increased risk was found when women with a history of LEEP were compared with women with a history cervical dysplasia but no cervical excision (pooled relative risk 1.08, 95% CI 0.88-1.33). Women with a history of LEEP have similar risk of preterm birth when compared with women with prior dysplasia but no cervical excision. Common risk factors for both preterm birth and dysplasia likely explain findings of association between LEEP and preterm birth, but LEEP itself may not be an independent risk factor for preterm birth.

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

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.

Transvaginal Ultrasonography in the Prediction of Preterm Birth After Treatment for Cervical Intraepithelial Neoplasia

To estimate whether cervical length measured by transvaginal ultrasonography in women having had loop electrosurgical excision procedure (LEEP), cold knife conization, or cryotherapy predicts spontaneous preterm birth. Women with a history of LEEP, cold knife conization, or cryotherapy and who were subsequently pregnant with singleton gestations were prospectively compared with both a low-risk control group and women with previous spontaneous preterm birth. A transvaginal ultrasonogram measuring cervical length was performed at 24 to 30 weeks of gestation. Primary outcomes included cervical length and spontaneous preterm birth less than 37 weeks. Secondary outcomes were spontaneous preterm birth less than 34 weeks, low birth weight, and maternal and neonatal outcomes. Women with previous LEEP (N = 75), cold knife conization (N = 21), and cryotherapy (N = 36) had shorter cervical lengths (3.54, 3.69, and 3.75 cm respectively) than the low-risk control group (N = 81, 4.21 cm) (P < .001, P = .03, P = .02 respectively) and similar lengths to women with a previous spontaneous preterm birth (N = 63, 3.78 cm). Loop electrosurgical excision procedure and cold knife conization, but not cryotherapy, were associated with spontaneous preterm birth less than 37 weeks (odds ratio 3.45, 95% confidence interval 1.28-10.00, P = .02; and odds ratio 2.63, 95% confidence interval 1.28-5.56, P = .009, respectively). Using a cutoff of 3.0 cm, transvaginal ultrasonography had a positive predictive value of 53.8% and negative predictive value of 95.2% for spontaneous preterm birth less than 37 weeks in women with LEEP. Women with a history of LEEP, cold knife conization, and cryotherapy all independently have shorter cervical lengths than low-risk controls and similar lengths to women with previous spontaneous preterm birth. Loop electrosurgical excision procedure and cold knife conization are associated with spontaneous preterm birth less than 37 weeks, and transvaginal ultrasonography predicts preterm birth in women who have had LEEP. II-2.