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Interval From Loop Electrosurgical Excision Procedure to Pregnancy and Pregnancy Outcomes

Conner, Shayna N. MD; Cahill, Alison G. MD, MSCI; Tuuli, Methodius G. MD, MPH; Stamilio, David M. MD, MSCE; Odibo, Anthony O. MD, MSCE; Roehl, Kimberly A. MPH; Macones, George A. MD, MSCE

doi: 10.1097/01.AOG.0000435454.31850.79
Contents: Original Research
Journal Club

OBJECTIVE: Previous studies have shown mixed results for pregnancy outcomes after loop electrosurgical excision procedure (LEEP); however, evidence is lacking regarding the pregnancy outcome of spontaneous abortion with respect to time elapsed from LEEP to pregnancy. We investigated risks of spontaneous abortion and preterm birth as they relate to time elapsed from LEEP to pregnancy.

METHODS: A 10-year, multicenter cohort study of women who underwent LEEP was performed between 1996 and 2006. Trained research nurses conducted telephone interviews with all patients to complete data extraction unavailable in charts. Median time from LEEP to pregnancy for spontaneous abortion compared with no spontaneous abortion and preterm birth before 34 and before 37 weeks of gestation compared with term birth were estimated. Patients with time intervals less than 12 months compared with 12 months or more from LEEP to pregnancy were then compared with identify adjusted odds ratios for spontaneous abortion and preterm birth.

RESULTS: Five hundred ninety-six patients met inclusion criteria. Median time from LEEP to pregnancy was significantly shorter for women with a spontaneous abortion (20 months [interquartile range 11.2–40.9] compared with 31 months [interquartile range 18.7–51.2]; P=.01) but did not differ for women with a term birth compared with preterm birth. Women with a time interval less than 12 months compared with 12 months or more were at significantly increased risk for spontaneous abortion (17.9% compared with 4.6%; adjusted odds ratio 5.6; 95% confidence interval 2.5–12.7). No increased risk was identified for preterm birth before 34 weeks of gestation or before 37 weeks of gestation.

CONCLUSION: Women with a shorter time interval from LEEP to pregnancy are at increased risk for spontaneous abortion but not preterm birth.

LEVEL OF EVIDENCE: II

Women with shorter time intervals from loop electrosurgical excision procedure to pregnancy are at increased risk for spontaneous abortion but not preterm delivery.

Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri.

Corresponding author: Shayna N. Conner, MD, Department of Obstetrics and Gynecology, Washington University School of Medicine, 4911 Barnes Jewish Hospital Plaza, Campus Box 8064, St. Louis, MO 63110; e-mail: conners@wudosis.wustl.edu.

Supported by National Institutes of Health grant (5R01CA10918604 to G.A.M.). Dr. Conner is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development T32 grant (22-3125-77026E) and the Washington University Institute of Clinical and Translational Sciences grant (UL1TR000448).

Presented as a poster at the annual meeting of the Society of Maternal Fetal Medicine, February 11–16, 2013, San Francisco, California.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.