Pregnancy Outcome Following Loop Electrosurgical Excision Procedure(LEEP) For Cervical Intraepithelial Neoplasia(CIN): A Meta-analysis

Objective Cervical intraepithelial neoplasia(CIN) is a kind of cervical precancerous lesions which is closely related to cervical cancer. The loop electrosurgical excision procedure(LEEP) has become one of the main treatment of CIN nowadays. But it still exists a lot of disputes about whether LEEP will affect the future fertility ability and pregnancy outcomes. This study aimed at assessing the association of the treatment safety and the related pregnancy outcomes with previous treatment of LEEP for CIN.Methods A thorough search of Pub Med、Cochrane Library、CNKI、CBM、Wanfang and Cq Vip electronic database was performed. Case-control studies about pregnancy outcomes after previous treatment of LEEP for CIN were collected and meta-analysis was carried out with Rev Man5.3 software, through an analysis of related pregnancy outcomes between study group(women with previous LEEP for CIN) and control group(women without previous cervical surgical history or health women), including the risk ratio(RR) and 95% confidence intervals(95%CI) of the incidence of pregnancy, miscarriage, ectopic pregnancy, induced labor, preterm delivery, cesarean section, premature rupture of membranes, placenta previa, postpartum hemorrhage, precipitate labour, forceps delivery and vacuum extraction delivery, cervical laceration, low birth weight, fetal distress, neonatal asphyxia and mortality.Result Forty case-control studies including 9002 patients were enrolled in this study with 4196 patients in study group and 4806 patients in control group. For women with previous LEEP for CIN, meta-analysis revealed that: ⑴. The incidence of miscarriage was significantly increased in study group as compared with that of control group(RR=1.34, 95%CI: 1.14~1.57, P﹤0.05), no significant difference was found in the incidence of pregnancy, ectopic pregnancy and induced labor with respect to the first, mid trimester of pregnancy between study group and control group(P>0.05 each); ⑵. ①. For maternal, LEEP was associated with a higher risk of preterm delivery(RR=1.60, 95%CI: 1.37~1.86, P﹤0.05), preterm premature rupture of membranes(RR=2.72, 95%CI: 1.46~5.07, P﹤0.05), cesarean section due to social factors(RR=2.12, 95%CI: 1.64~2.76, P﹤0.05), no significant difference was found in the incidence of premature rupture of membranes, cesarean section, placenta previa, postpartum hemorrhage in regard to the perinatal period(the late trimester of pregnancy) between study group and control group(P>0.05 each); ②. For perinatal infants, the incidence of low birth weight was obviously increased in study group(RR=1.35, 95%CI: 1.10~1.66, P﹤0.05), no significant difference was found in the incidence of fetal distress、neonatal asphyxia and mortality during perinatal period between study group and control group(P>0.05 each); ③. For delivery way and complications, LEEP was not associated with a significantly increased risk of precipitate labour, forceps delivery and vacuum extraction delivery, and cervical laceration(P>0.05 each).Conclusion LEEP is associated with an increased risk of miscarriage, preterm delivery, preterm premature rupture of membranes, cesarean section due to social factors, low birth weight. For CIN patients with fertility requirements, the risk of adverse pregnancy outcomes should be fully informed before LEEP.