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Pregnancy outcome following loop electrosurgical excision procedure (LEEP) a systematic review and meta-analysis

Archives of Gynecology and Obstetrics volume 289, pages 85–99 (2014)Cite this article

Abstract

Objective

This study aimed at assessing the association of the relative risk (RR) of adverse pregnancy outcomes with previous treatment of loop electrosurgical excision procedure (LEEP) for the management of cervical intraepithelial neoplasia (CIN).

Methods

Data sources were from MEDLINE, EMBASE, and SCI citation tracking. Selection criteria: The eligible studies had data on pregnancy outcomes of women with or without previous treatment for CIN. Considered outcomes were severe preterm delivery (<34/32 weeks), extreme preterm delivery (<28 weeks), low birth weight (<2,500 g), stillbirth, preterm spontaneous rupture of membranes, perinatal mortality, and neonatal mortality and induction.

Results

36,954 cases and 1,794,174 controls in 4 prospective cohort and 22 retrospective studies were included in this meta-analysis. LEEP was associated with a higher risk of severe preterm delivery (<32 weeks, relative risk 1.98, 95 % CI [1.31, 2.98] 159/11,337 vs. 7,830/860,883), extreme preterm delivery (<28 weeks, RR, 2.33, 95 % CI [1.84, 2.94] 97/9,611 vs. 1,559/618,332), preterm premature rupture of the membranes (RR, 1.88, 95 % CI [1.54, 2.29] 126/2,837 vs. 7,899/313,094), and low birth weight (<2,500 g, RR, 2.48, 95 % CI [1.75, 3.51] 110/1,451 vs. 55/1,742). A cervical length of less than 3 cm was significantly increased in LEEP as compared with that of control group (RR, 4.88, 95 % CI [1.56, 15.25]), but increasing LEEP volume or depth was not associated with an increased rate of preterm birth <37 weeks. And LEEP was not associated with a significantly increased risk of perinatal mortality, cesarean section, stillbirth mortality, neonatal mortality, induction, and neonatal intensive care unit admission.

Conclusions

LEEP is associated with an increased risk of subsequent preterm delivery (<32/34, <28 weeks) and other serious pregnancy outcomes. But increasing LEEP volume or depth is not associated with an increased rate of preterm birth.

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Authors and Affiliations

  1. West China Second Hospital, Sichuan University, No.20, the Third Part of Renmin Road, Wuhou District, Chengdu, 610041, Sichuan Province, People’s Republic of China

    Gong Jin, Chen Li & Zhang Dan

  2. West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China

    Zhang LanLan

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  1. Gong Jin
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  2. Zhang LanLan
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  3. Chen Li
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  4. Zhang Dan
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Corresponding author

Correspondence to Zhang Dan.

Additional information

G. Jin and Z. LanLan contributed equally to this work.

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Jin, G., LanLan, Z., Li, C. et al. Pregnancy outcome following loop electrosurgical excision procedure (LEEP) a systematic review and meta-analysis. Arch Gynecol Obstet 289, 85–99 (2014). https://doi.org/10.1007/s00404-013-2955-0

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  • DOI: https://doi.org/10.1007/s00404-013-2955-0

Keywords

  • Cervical intraepithelial neoplasia (CIN)
  • Cesarean section (CS)
  • Cervical volume
  • Large loop excision of the transformation zone (LLETZ)
  • Loop electrosurgical excision procedure (LEEP)
  • Lower birth weight (LBW)
  • Preterm delivery (PD)
  • Perinatal mortality (PM)
  • Pregnancy outcome
  • Preterm spontaneous rupture of membranes (PPROM)
  • Stillbirth mortality