Obstetric outcomes in patients that underwent loop electrosurgical excision procedures
DOI:
https://doi.org/10.51481/amc.v56i4.855Keywords:
Obstetric labor, fetal membranes, premature membrane ruptureAbstract
Background: Treatment of intraepithelial lesions could be a risk factor for preterm delivery and / or premature rupture of membranes. The purposeof this study was to compare the obstetric outcomes of patients attended at the Obstetrics and Gynecology Service of the Rafael Angel Calderon Guardia Hospital with a history of LEEP with those of the general pregnant population without such history.
Methods: We conducted a retrospective cohort study that included 68 patients in a reproductive age who underwent LEEP in the period 2005-2009 with subsequent pregnancies and deliveries until December 31, 2012. To compare the results with those of the general pregnant population, we chose randomly 204 patients not exposed to LEEP with delivery dates similar to those of thepatients exposed to LEEP (1:3 ratio). We compared variables concerning prenatal care, labor and the newborn between both groups.
Results: On the one hand, the percentage of patients with preterm delivery in the exposed group was 10.7% (n = 8) and in the unexposed group was 11.8% (n = 22). This difference was not statistically significant (p = 0.40, RR 0.91, 95% CI 0.3 to 2.1). On the other hand, the percentage of patients with premature rupture of membranes was higher in the exposed group (27.9%, n = 19) than in the unexposed group (7.3%, n = 15). This difference was statistically significant (p <0.01, RR 3.8 95% CI 2.3 to 10.3).
Conclusions: The loop electrosurgical excision procedure (LEEP) represented a risk factor for premature rupture of membranes but not for preterm delivery.
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References
Castle PE, Sideri M, Jeronimo J, Solomon D, Schiffman M. Risk Assessment to guide the prevention of cervical cancer. Am J Obstet Gynecol 2007;197:356. e1-6.
Echelman D, Feldman S. Management of cervical precancers: A global perspective. Hematol Oncol Clin N Am 2012;26:31-44.
Long S, Leeman L. Treatment options of high grade squamous intraepithelial lesion. Obstet Gynecol Clin N Am 2013;40:291-316.
Sandler L, Saftlas A, Wang W, Exeter M, Whittaker J, McCowan L. Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA 2004; 291: 2100-2106.
Samson SL, Bentley JR, Fahey TJ, McKay DJ, Gill GH. The effect of loop electrosurgical excision procedure on future pregnancy outcome. Obstet Gynecol 2005;105:325.332.
Kyrgiou M, Koliopoulos G, Martin-Hirsch P Arbyn M, Prendiville W, Paraskevaidis E. Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and metaanalysis. Lancet 2006;367:489.
Noehr B, Jesen A, Frederiksen K, Tabor A, Kjaer S. Loop electrosurgical excision of the cérvix and subsequent risk for spontaneous preterm delivery: A population-based study of singleton deliveries during a 9-year period. Am J Obstet Gyecol 2009; 201: 33e1-33e6.
Bruinsma F, Lumley J, Tan J, Quinn M. Precancerous changes in the cervix and risk of subsequent preterm birth. BJOG 2007;114:70.
Arbyn M, Kyrgiou M, Simoens C, Raifu A, Koliopoulos G,Martin-Hirsch P, et al. Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ 2008; 337:a1284.
Werner CL, Lo JY, Heffernan T, Griffith WF, McIntire DD, Leveno KJ. Loop electrosurgical excision procedure and risk of preterm birth. Obstet Gynecol 2010;115:605.
Shanbhag S, Clark H, Timmaraju V, Bhattacharya S, Cruickshank M. Pregnancy outcome after treatment for cervical intraepithelial neoplasia. Obstet Gynecol 2009;114:727-735.
Suh-Burgmann EJ, Whall-Strojwas D, Chang Y, Hundley D. Risk factors for cervical stenosis after loop electrosurgical excision prcedure. Obstet Gynecol 2000;96:657-660.
Frey H, Stout M, Stamilio D, Cahill A, Roehl K, Macones G. Risk of cesarean delivery following loop electrosurgical excision procedure (LEEP). Am J Obstet Gynecol 2012;206(1 Suppl); S292.
Frey H, Stout M, Stamilio D, Cahill A, Roehl K, Macones G. Risk of cesarean delivery following loop electrosurgical excision procedure. Obstet Gynecol 2013;121:39-45.
Mercer B. Preterm premature ruptura of the membranes. Obstet Gynecol 2003;101:178-193.
ACOG. Management of preterm labor, Practice Bulletin. Obstet Gynecol 2012; 119:1308-1317.
ACOG. Premature rupture of membranes, Practice Bulletin. Obstet Gynecol 2013;139:918-930.
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