Pregnancy outcome and risk of recurrence after tissue-preserving LOOP Electrosurgical Excision Procedure (LEEP)

Abstract

Background/Purpose: This study aims to investigate whether women with cervical dysplasia after LEEP have an increased risk of pregnancy/childbirth complications or recurrence of dysplasia in an upcoming pregnancy. Methods: Data from 240 women after LEEP were analysed retrospectively. The reference group consisted of 956 singleton births. Fisher and Wilcoxon rank tests were used to detect differences between groups. Using logistic regressions, we analysed the effect of surgery specific aspects of LEEP on pregnancy/childbirth complications and the frequency of CIN recurrences. Results: We found that tissue preserving LEEP did not lead to premature birth or miscarriage and did not increase the likelihood of CIN recurrence. We did not observe differences regarding preterm birth (< 37 (p < 0.28) < 34 (p < 0.31), < 32 weeks of gestation (p < 0.11)) or birth weight (< 2500g (p < 0.54), < 2000g (p < 0.77) between groups. However, women after LEEP exhibit a higher risk of premature rupture of membranes 2 (PROM) at term (p < 0.009) and vaginal infections (p < 0.06). Neither volume nor depth of the removed tissue nor an additional endocervical resection seem to influence the likelihood of premature birth or early miscarriage. Performing an endocervical resection protects against CIN recurrence (OR = 0.0881, p < 0.003). Conclusions: After tissue-preserving LEEP, there is an increased risk of vaginal infections and PROM at term in consecutive pregnancy. LEEP does not affect prematurity or miscarriage. The removal of additional endocervical tissue appears to be a protective factor against recurrence of CIN.