Archives of Gynecology and Obstetrics

, Volume 272, Issue 2, pp 109–112 | Cite as

Pregnancy outcome after loop electrosurgical excision procedure for the management of cervical intraepithelial neoplasia

  • Ganesh Acharya
  • Ingvild Kjeldberg
  • Sidsel Mordt Hansen
  • Nils Sørheim
  • Bjarne Koster Jacobsen
  • Jan Martin Maltau
Original Article


Objective: Previous studies have shown conflicting results on the outcome of pregnancy following loop electrosurgical excision procedure (LEEP). The purpose of this study was to evaluate whether LEEP affects the outcome of pregnancy after 20 weeks’ gestation. Methods: This is a matched cohort study of all women who had a LEEP for a biopsy-confirmed cervical intraepithelial neoplasia (CIN) in between December 1995 and December 2000 and subsequently delivered (after 20 weeks’ gestation) at the University Hospital of Northern Norway. Women who had an ectopic pregnancy or an abortion (spontaneous or induced) following LEEP were excluded from analysis. Two controls matched for the date of delivery, age, parity, previous obstetric history and smoking habit were identified for each case using routinely entered data from the birth register. The main outcome measures were the duration of pregnancy and birth weight. Other variables recorded included the grade of cervical dysplasia, size of the electrosurgical loop, age, parity, pregnancy complications, mode of delivery, and perinatal outcome. Results: Of a total of 428 women of reproductive age who had LEEP performed during the study period, 89 had a pregnancy after the procedure. Ten women were excluded (three ectopic pregnancies, two induced abortions and five spontaneous abortions) from the study. Data from 79 women whose pregnancies progressed beyond 20 weeks and 158 matched controls were analysed. The mean age at the time of LEEP was 27 (range 19–36) years. The histological diagnosis was normal in 3 (3.8%), CIN1 in 5 (6.3%), CIN2 in 18 (22.8%), and CIN3 in 53 (67.1%) of the cases. Overall, mean gestation at delivery (38.3 vs. 39.1 weeks), mean birth weight (3,412 vs. 3,563 g), prevalence of preterm birth (11.4% vs. 10.8%) and low birth weight (10.1 vs. 5.1%) were not significantly different among the cases and controls. But when a relatively large loop (25 mm) had been used, the risk of preterm delivery (odds ratio 4.0) and low birth weight (odds ratio 14.0) was significantly higher than in controls. Pregnancy complications occurred more frequently (20 vs. 7%; p=0.006) among the cases than the controls. Conclusion: LEEP in women with CIN did not significantly increase the risk of low birth weight or preterm birth in subsequent pregnancy in comparison to their controls, except when the size of electrosurgical loop was relatively large. However, the prevalence of pregnancy complications was significantly higher after LEEP.


Cervical intra-epithelial neoplasia Loop electrosurgical excision Complication 


  1. Althuisius SM, Schornagel IJ, Dekker GA, van Geijn HP, Hummel P (2001) Loop electosurgical excision procedure of the cervix and time of delivery in subsequent pregnancy. Int J Gynecol Obstet 72:31–34CrossRefGoogle Scholar
  2. Bigrigg MA, Codling BW, Pearson P, Read MD, Swingler GR (1991) Preganncy after cervical loop diathermy. Lancet 337:119CrossRefGoogle Scholar
  3. Bigrigg A, Haffenden DK, Sheehan AL, Codling BW, Read MD (1994) Efficacy and safety of large-loop excision of the transformation zone. Lancet 343:32–34CrossRefPubMedGoogle Scholar
  4. Blomfield PI, Buxton J, Dunn J, Luesley DM (1993) Pregnancy outcome after large loop excision of the cervical transformation zone. Am J Obstet Gynecol 169:620–625PubMedGoogle Scholar
  5. Braet PG, Peel JM, Fenton DW (1994) A case controlled study of the outcome of pregnancy following loop diathermy excision of the transformation zone. J Obstet Gynaecol 14:79–82Google Scholar
  6. Brun JL, Youbi A, Hocke C (2002) Complications, sequellae and outcome of cervical conizations: evaluation of three surgical technics. J Gynecol Obstet Biol Reprod (Paris) 31:558–564Google Scholar
  7. Cruickshank ME, Flannelly G, Campbell DM, Kitchener HC (1995) Fertility and pregnancy outcome following large loop excision of the cervical transformation zone. Br J Obstet Gynaecol 102:467–470PubMedGoogle Scholar
  8. Dey P, Gibbs A, Arnold DF, Saleh N, Hirsch PJ, Woodman CBJ (2002) Loop diathermy excision compared with cervical laser vaporization for the treatment of intraepithelial neoplasia: a randomized controlled trial. BJOG 109:381–385PubMedGoogle Scholar
  9. Fanning J, Padratzik J (2002) Cold knife conization vs. LEEP. Are they the same procedure? J Reprod Med 47:33–35PubMedGoogle Scholar
  10. Ferenczy A, Choukroun D, Falcone T, Franco E (1995) The effect of cervical loop electrosurgical excision on subsequent pregnancy outcome: North American experience. Am J Obstet Gynecol 172:1246–1250CrossRefPubMedGoogle Scholar
  11. Forsmo S, Hansen MH, Jakobsen BK, Øian P (1996) Pregnancy outcome after laser surgery for cervical intraepithelial neoplasia. Acta Obstet Gynecol Scand 75:139–143PubMedGoogle Scholar
  12. Gentry DJ, Baggish MS, Brady K, Walsh PM, Hungler MS (2000) The effects of loop excision of the transformation zone on cervical length: implications for pregnancy. Am J Obstet Gynecol 182:516–520PubMedGoogle Scholar
  13. Gunasekera PC, Lewis BV, Phipps JH (1992) Obstetric outcome after cervical surgery for intra-epithelial neoplasia. J Obstet Gynaecol 12:291–293Google Scholar
  14. Haffenden DK, Bigrigg A, Codling BW, Read MD (1993) Pregnancy following large loop excision of the transformation zone. Br J Obstet Gynaecol 100:1059–1060PubMedGoogle Scholar
  15. Hagen B, Skjeldestad FE (1993) The outcome of pregnancy after CO2 laser conisation of the cervix. Br J Obstet Gynaecol 100:717–720PubMedGoogle Scholar
  16. Kainz C, Tempfer C, Sliutz G, Breitenecker G, Reinthaller A (1996) Radiosurgery in the management of cervical intraepithelial neoplasia. J Reprod Med 41:409–414PubMedGoogle Scholar
  17. Keijser KGG, Kenemans P, van der Zaden PHThH, Schijf CPT, Vooijs GP, Rolland R (1992) Diathermy loop excision in the management of cervical intraepithelial neoplasia: diagnosis and treatment in one procedure. Am J Obstet Gynecol 166:1281–1287PubMedGoogle Scholar
  18. Kristensen J, Langhoff-Roos J, Wittrup M, Bock JE (1993) Cervical conization and preterm delivery/low birth weight: a systematic review of the literature. Acta Obstet Gynecol Scand 72:640–644PubMedGoogle Scholar
  19. Leiman G, Harrison NA, Rubin A (1980) Pregnancy following conization of the cervix: complications related to cone size. Am J Obstet Gynecol 136:14–18PubMedGoogle Scholar
  20. Ludviksson K, Sandström B (1982) Outcome of pregnancy after cone biopsy—a case-control study. Eur J Obstet Gynec Reprod Biol 14:135–142Google Scholar
  21. Mathevet P, Dargent D, Roy M, Georges B (1994) A randomized prospective study comparing three techniques of conization: cold knife, laser, and LEEP. Gynecol Oncol 54:175–179PubMedGoogle Scholar
  22. Monaghan JM, Kirkup W, Davis JA, Edington PT (1982) Treatment of cervical intraepithelial neoplasia by colposcopically directed cryosurgery and subsequent pregnancy experience. Br J Obstet Gynaecol 89:387–392PubMedGoogle Scholar
  23. Prendiville W, Gillimore J, Norman S (1989) Large loop excision of the transformation zone (LEEP): a new method of management for women with cervical intraepithelial neoplasia. Br J Obstet Gynaecol 96:1054–1060PubMedGoogle Scholar
  24. Raio L, Ghezzi F, Di Naro E, Gomez R, Lüscher KP (1997) Duration of pregnancy after carbon dioxide laser conization of the cervix: influence of cone height. Obstet Gynecol 90:978–982PubMedGoogle Scholar
  25. Sadler L, Saftlas A, Wang W, Exeter M, Whittaker J, McCowan L (2004). Treatment of cervical intraepithelial neoplasia and risk of preterm delivery. JAMA 291:2100–2106PubMedGoogle Scholar
  26. Singer A, Walker P (1985) The treatment of CIN: conservative methods. Clin Obstet Gynaecol 12:121–132PubMedGoogle Scholar
  27. Tan L, Pepra E, Haloob RK (2004) The outcome of pregnancy after large loop excision of the transformation zone of the cervix. J Obstet Gynaecol 24:25–27PubMedGoogle Scholar
  28. Tarrant MJ, Gordon H (1993) Pregnancy outcome following large loop excision of the transformation zone. J Obstet Gynaecol 13:348–349Google Scholar
  29. Turlington WT, Wright BD, Powell JL (1996) Impact of loop electrosurgical excision procedure on future fertility. J Reprod Med 41:815–818PubMedGoogle Scholar
  30. Van Rooijen M, Persson E (1999) Pregnancy outcome after laser vaporization of the cervix. Acta Obstet Gynecol Scand 78:346–348PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Ganesh Acharya
    • 1
  • Ingvild Kjeldberg
    • 1
  • Sidsel Mordt Hansen
    • 1
  • Nils Sørheim
    • 1
  • Bjarne Koster Jacobsen
    • 2
  • Jan Martin Maltau
    • 1
  1. 1.Department of Obstetrics and GynaecologyUniversity Hospital of Northern NorwayTromsøNorway
  2. 2.Institute of Community MedicineUniversity of TromsøTromsøNorway

Personalised recommendations