Nancy A. Melville

February 09, 2012

February 9, 2012 (Dallas, Texas) — Patients who undergo loop electrosurgical excision procedures (LEEP) are at no greater risk for preterm birth or pregnancy loss, according to a large multicenter study presented here at the Society for Maternal-Fetal Medicine 32nd Annual Meeting.

Findings from previous studies have raised concerns that LEEP could prompt later pregnancy complications, but this study, comparing pregnancy outcomes, over 7 years, in women who underwent the procedure and those who had normal Pap tests or cervical punch biopsies, showed no significant increase in risk.

Researchers from Washington University in Saint Louis, Missouri, evaluated the pathology records from 9 hospitals of patients undergoing LEEP, cervical punch biopsy, or normal Pap testing from 2000 to 2006.

The subjects were 625 women who had previously undergone LEEP, 602 who had previously undergone a cervical punch biopsy, and 616 who had only undergone Pap testing.

The numbers of women having preterm births (less than 34 weeks of gestation) were 48 (7.7%) of 625, 33 (5.5%) of 602, and 45 (7.3%) of 616; in the 3 groups, respectively.

The rate of pregnancy loss prior to 20 weeks in the 3 groups was not statistically significantly different (5.9% for LEEP; 3.6% for cervical punch biopsy; 4.2% for Pap testing).

The rates remained consistent after adjustment for variables such as age, ethnicity, body mass index, smoking, and previous preterm delivery.

"Contrary to prior publications, in this large, well-characterized, generalizable cohort, LEEP was not associated with subsequent adverse pregnancy outcomes," the authors write. Women who have undergone LEEP "do not require increased surveillance or intervention for the prevention of preterm birth or early pregnancy loss."

Lead author George A. Macones, MD, MSCE, who is the Mitchell and Elaine Yanow Professor and chair of the Department of Obstetrics and Gynecology at Washington University, noted that the improved design of the study might explain why the results differ from previous research.

"This was not the largest study looking at LEEP and pregnancy outcome, but it was among the largest, and I would say that there may be some more rigor to our study, compared with others," said Dr. Macones.

"I was concerned about some of the methods used in the previous studies, so I was not surprised by these new findings at all," he told Medscape Medical News.

"This basically means that patients with a prior LEEP do not need additional tests or interventions. I think that is an important finding."

George Saade, MD, professor of obstetrics and gynecology at the University of Texas in Galveston, who moderated the session, agreed that the potential to reduce unnecessary testing for women who have previously undegone LEEP is a major development.

"This is a very important study that focuses on a significant topic," said Dr. Saade.

"Currently, there is a widely held belief that women who had LEEP before pregnancy are at risk of pregnancy loss and preterm labor. Such patients frequently undergo repeated ultrasounds to check their cervix, and sometimes end up receiving a cervical cerclage," he told Medscape Medical News.

"This study showed for the first time, conclusively, that these women are not at increased risk for these complications. The results should have a major impact on the management of such patients, and should prevent unnecessary testing and intervention."

The findings should allow clinicians and women wishing to become pregnant to take advantage of the usefulness of LEEP without fearing later adverse effects on a pregnancy, he added.

"Women who had a LEEP, and those who need a LEEP, should be reassured that they do not have a higher risk of pregnancy loss or preterm birth than those who did not have a LEEP," Dr. Saade noted. "The study is well designed.... It provides a definite answer to this issue.

The study was funded by the National Cancer Institute, grant RO1 CA109186.

Society for Maternal-Fetal Medicine (SMFM) 32nd Annual Meeting: Abstract 5. Presented February 9, 2012.

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