Loop electrosurgical excision of the cervix and the subsequent risk of preterm delivery

Nøhr, Bugge; Tabor, Ann; Frederiksen, Kirsten; Kjær, Susanne K.

doi:10.1080/00016340701279145

Cited by 57 publications

(52 citation statements)

References 25 publications

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“…To further investigate the effect of the type of study design and analysis, studies using an external comparison group were analysed according to whether the study carried out no adjustment, the study was matched or multivariable modelling was used, for the most commonly used excisional treatment type, namely LEEP. The risk of preterm birth associated with LEEP was similar when only studies adjusting for a range of possible confounders (RR 1.84, 95% CI 1.63-2.08) 2,11,12,38 were included compared with when raw data were used (RR 1.85, 95% CI 1.59-2.15).…”

Section: Association Of Excisional Methods Of Treatment and Preterm Bmentioning

confidence: 81%

“…Studies used a range of different comparison groups and some studies used multiple types of comparison groups (Table S1). Only three studies 12,23,36 examined pregnancy outcomes prospectively, all the rest were conducted retrospectively.…”

Section: Study Selectionmentioning

confidence: 99%

“…4 In addition, a systematic review (without meta-analysis) was published in 2007. 5 A number of large studies [6][7][8][9][10][11][12][13][14] examining this question have been published since the most recent review, 3 making it timely to update the analysis and examine methodological issues that may influence the findings.…”

Section: Introductionmentioning

confidence: 99%

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The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis

Bruinsma

Quinn

2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

201

145

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Background Studies investigating the association between treatment for precancerous changes in the cervix and risk of preterm birth have used a variety of comparison groups.Objectives To investigate whether treatment for precancerous changes in the cervix is associated with preterm birth (<37 weeks) and to examine the impact of the type of comparison group on estimates of risk.Search strategy PubMed, Embase and CENTRAL were searched for studies pubished between 1950 and 2009.Selection criteria Eligible studies were those that reported preterm birth outcomes for excisional and ablative treatments separately and included a comparison group.Data collection and analysis Pooled relative risks (RR) and 95% confidence intervals were computed using a random effects model.Main results Thirty eligible studies were located. Excisional treatment was associated with an increased odds of preterm birth, when compared with an external (RR 2.19, 95% CI 1.93-2.49) or internal (RR 1.96, 95% CI 1.46-2.64) comparison group. In comparison with women who were assessed but not treated, the risk estimate was smaller (RR 1.25, 95% CI 0.98-1.58). Ablative treatment was associated with an increased risk of preterm birth when an external comparison group (RR 1.47, 95% CI 1.24-1.74) but not an internal comparison group (RR 1.24, 95% CI 0.73-2.10) or untreated comparison group (RR 1.03, 95% CI 0.90-1.18) was used.

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Section: Association Of Excisional Methods Of Treatment and Preterm Bmentioning

confidence: 81%

Section: Study Selectionmentioning

confidence: 99%

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The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis

Bruinsma

Quinn

2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

201

145

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“…The overall obstetric outcomes after electrosurgical excision in our study showed different results from earlier reports by others. [15][16][17] Common conclusions of earlier studies were that the diathermy loop excision does not affect fertility and pregnancy outcome. However, none of these studies seem to have analyzed the overall rates of pregnancy and preterm delivery after conization, even in a single institute.…”

Section: Discussionmentioning

confidence: 87%

The role of prophylactic cerclage in preventing preterm delivery after electrosurgical conization

et al. 2010

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Objective: To evaluate pregnancy outcomes after electrosurgical conization. Methods: We retrospectively analyzed the outcomes of 56 singleton pregnancies after electrosurgical conization of the uterine cervix. Of the 56 cases, 25 women underwent prophylactic cerclage with McDonald procedure (cerclage group), and 31 were managed expectantly (expectant group). Pregnancy outcomes including rate of preterm delivery were compared, and the effect of potential risk factors such as depth of cone, interval between conization and pregnancy, and cervical length on the risk of preterm delivery was assessed. Results: The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization than those without (32.1% vs. 15.2%, p＜0.001). However, preterm delivery rate was not different between the two groups (expectant group vs. cerclage group; ＜28 week, 6.5% vs. 8.0%, p=1.000; ＜34 week, 19.4% vs. 20.0%, p=1.000; ＜37 week, 29.0% vs. 36.0%, p=0.579). All obstetric and neonatal outcomes were similar in the two groups. Even when we confined the study subjects to 19 women (19/56, 33.9%) with cervical length less than 25 mm, the preterm delivery rate also was not significantly different between the expectant (n=7) and cerclage group (n=12). Finally, the potential risk factors for preterm delivery were not associated with risk of preterm delivery in patients with a history of electrosurgical conization. Conclusion:The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization before pregnancy. However, prophylactic cervical cerclage did not prevent preterm delivery in these patients.

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“…16 Nohr B et al concluded that there is almost 2 fold increased risk of preterm labour after loop electrosurgical excision of the cervix. 17 In our study 6% patients had history of infertility in the past. Similarly Thyagarajan C et al concluded that there is increased incidence of preterm labour in females with history of infertility.…”

Section: Discussionmentioning

confidence: 99%

Can preterm birth be gainfully prevented?

Bala

Kaur

Nagpal

2017

Int J Reprod Contracept Obstet Gynecol

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Loop electrosurgical excision of the cervix and the subsequent risk of preterm delivery

Abstract: Our study showed an almost 2-fold increase in the risk of preterm delivery after LEEP treatment. Thus, women in their reproductive age should be informed about the increased risk of preterm delivery, if treated with LEEP.

Cited by 57 publications

References 25 publications

The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis

The risk of preterm birth following treatment for precancerous changes in the cervix: a systematic review and meta-analysis

The role of prophylactic cerclage in preventing preterm delivery after electrosurgical conization

Can preterm birth be gainfully prevented?

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