COMMENTARY

Does LEEP Invariably Increase the Risk for Preterm Birth?

Andrew Kaunitz, MD

Disclosures

September 14, 2012

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Hello. I'm Andrew Kaunitz, Professor and Associate Chair of the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville, Florida. Today I'd like to ask, does treatment of cervical intraepithelial neoplasia (CIN) invariably increase the risk for preterm birth?

Published reports indicate that loop electrosurgical excision procedure (LEEP), as well as other treatments for CIN, increase the risk for subsequent preterm birth. In Britain, women with abnormal cervical cancer screening results are referred to specialized clinics for colposcopy. When appropriate, LEEP represents the most commonly used treatment for these women.

Focusing on high-volume clinics that see more than 550 new patients annually, Castanon and colleagues[1] constructed a cohort of women who had a cervical punch biopsy only (the untreated group) or treatment for CIN (the treatment group). Previous as well as subsequent births to women in this cohort were assessed with respect to gestational age at delivery. Risk factors for preterm birth (defined as birth before 37 weeks' completed gestation) were compared within the cohort.

Among women in the cohort who had a delivery after colposcopy, the risk for preterm delivery was higher in the treatment group than in the untreated group. However, among women who had a childbirth prior to colposcopy, the risk for preterm birth also was higher in women who were subsequently treated than not treated. Among treated women, the risk for preterm birth was marginally lower following treatment than before treatment.

The observation that the risk for preterm birth was higher in women post-treatment than in untreated women would appear to confirm conclusions of earlier reports that LEEP for CIN increases the risk for preterm birth. However, prior to evaluation for CIN, women destined to have treatment for this condition also had a higher risk for preterm delivery. Furthermore, among women who gave birth before and after treatment, the risk for preterm delivery did not increase following treatment.

These observations provide strong evidence that in women receiving care at British high-volume specialty clinics, treatment for CIN does not increase the risk for subsequent preterm birth. Castanon and colleagues suggest that clinicians working in these highly monitored British clinics may remove less tissue during CIN treatment than other clinicians, thereby minimizing subsequent risk for preterm birth. The findings of this important study should cause us to give thought to how we treat CIN.

Thank you. I am Andrew Kaunitz.

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