Cervical Loop Electrosurgical Excision (LEEP)
Six months ago, I had a electric loop excision to remove a dime-sized lesion of precancerous cells from the tip of my cervix. Am I at risk for incompetent cervix? I am 23, in generally good health and I'd like to get pregnant in about a year.Question:
The short answer to this is that the research (two articles of which are abstracted below) does not show a relationship between this procedure and adverse pregnancy outcome. Individual clients who have had a LEEP and subsequently experience any pregnancy loss, however, feel that these may be related. The procedure is becoming more common as more women experience abnormal pap smears and cervical pathology.
In my experience, the two have not been related, and the LEEP is much more protective of cervical competence than older techniques such as a cone biopsy.
I hope this helps.
Wright TC Jr. Richart RM.
Loop excision of the uterine cervix. [Review]
"Current Opinion in Obstetrics & Gynecology." 7(1):30-4, 1995 Feb.
Over the past three years, loop excision has become a standard form of therapy for cervical intraepithelial neoplasia. Clinical trials have found loop excision to be faster and easier than laser ablation for treating cervical intraepithelial neoplasia and to have similar complication and success rates. In addition, loop excision produces a specimen that is suitable for histopathologic evaluation in the majority of patients. As our clinical experience with loop excision has increased, little impact on fertility and pregnancy outcome has been found, but there continues to be concern about overuse of the technique as a method of evaluating women with low-grade abnormal Papanicolaou smears. [References: 46]Authors
Ferenczy A. Choukroun D. Falcone T. Franco E.
The effect of cervical loop electrosurgical excision on subsequent pregnancy outcome: North American experience.
"American Journal of Obstetrics & Gynecology." 172(4 Pt 1):1246-50, 1995 Apr.
OBJECTIVE: Our purpose was to determine pregnancy outcome and parturition in women who were treated by loop electrosurgical excision for squamous intraepithelial lesions. STUDY DESIGN: A series of 574 consecutive women of reproductive age (15 to 44 years old) were treated by loop electroexcision for low- and high-grade squamous intraepithelial lesions. The incidence of pregnancies was determined in these women within a three-year period after therapy by comparing the "observed" number of pregnancies with the "expected" number of pregnancies in the study population, assuming that fertility rates in these women were the same as in the untreated general female population. Pregnancy outcome was correlated in the 53 women who were delivered of an infant with the posttreatment appearance of the cervix and birth weight with maternal smoking. RESULTS: The incidence of pregnancy in the study population was 8.5 per 100 woman years compared with 7.4 per 100 woman years in the untreated central population. Fifty-three women had 54 pregnancies, of which 46 (84 percent) were live births either at term (40) or between 37 and 39 weeks of gestation (6), and three patients are at present at 24, 34, and 36 weeks of gestation. There were two stillbirths and three first-trimester spontaneous abortions. Premature delivery was not observed. External os stenosis (one case), shortening of the cervix (one case), and repeat electroexcision (four cases) had no adverse effect on pregnancy and parturition. Smoking or = 10 cigarettes per day before and during pregnancy, rather than loop electrosurgical excision per se, was associated with lower-birth-weight babies than those of nonsmokers (p < 0.01). CONCLUSION: Loop electrosurgical excision to a maximum depth of 1.5 cm and a mean frontal diameter of 1.8 cm does not appear to have adverse effects on subsequent pregnancy outcome and parturition.