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Saturday, March 29, 2014

Trailers (78): LEEP and preterm birth

Conner, et al.  Loop electrosurgical excision procedure and risk of preterm birth: a systematic review and meta-analysis

Why should you read about this topic?

Because the question never seems to go away: is LEEP associated with preterm birth?

What were the authors trying to do?

Determine whether LEEP is associated with preterm birth and if so, whether it is attributable to the condition or the treatment

Who participated and in what setting?

Studies (N=19) of pregnant women who had LEEP for dysplasia (N=6,589) compared with no treatment in women (N=1,415,015) with or without dysplasia

What was the study design?

Meta-analysis of observational studies

What were the main outcome measures?

Rates of preterm births

What were the results?

LEEP was associated with an increased rate of preterm birth (RR 1.65) compared with women with no or unknown history of dysplasia.  However, there was no increased rate of preterm birth compared with women with a history of dysplasia but no LEEP.

What is the most interesting image in the paper?

Figure 3

What were the study strengths and weaknesses?

Strengths: clear criteria for study quality assessment (selection bias, outcome independence, and data source quality); two types of unexposed comparison groups (dysplasia, no dysplasia). Weaknesses: unrealistically low rate of preterm birth in the exposed (8.8%) and unexposed (5.1%) groups; some of the included studies were outdated.

What does the study contribute for your practice?

Maybe it’s not the treatment but the condition that conveys the increased risk of preterm birth.  Push the HPV vaccine