Study On The Relationship Between Loop Electrosurgical Excisional Procedure (LEEP) And Pregnancy Outcomes And Its Clinical Application

Objective: To explore the association between loop electrosurgical excisional procedure(LEEP)and adverse pregnancy outcomes according to the time interval from LEEP to subsequent conception.To explore the clinical application of LEEP and research progress of cervical excisional treatment.Methods: A multicenter retrospective-prospective cohort study taken in five National Public Hospital in South-West China.Women with cervical intraepithelial neoplasia underwent LEEP between May 2013 and May2018,linked by hospital episode statistics or questionnaire to obstetric records between May 2013 and December 2020 to identify singleton live births between 28-42 gestational weeks before and after LEEP treatment were included.we retrospectively obtained the date of the maternal age at delivery,BMI,parity and obstetric outcomes(included PTB,PROM,LBW and cesarean section)of previous births before LEEP,and the LEEP treatment relevant dimensions(that is,whether it combined TCT abnormal,HPV infection,cone depth and cone radius).We obtained the subsequent pregnancy outcomes after LEEP(included PTB,PROM,PPROM,chorioamnionitis,LBW and cesarean section).We analyzed the time interval from LEEP to subsequent conception in all births.The time interval was divided into subgroups of 0-6 months,6-12 months,12-24 months,24-36 months,36-48 months and>48 months.To explore the association between LEEP and adverse pregnancy outcomes according to the time interval.Objective To retrospectively analyze the total number of colposcopies and LEEP in single-center gynecological clinic from 2013 to2017,and analyze the clinical application of LEEP.Literature review of cervical excisional treatment from 2000 to 2020,to analyze its research progress.Results: 347 singleton births(6.70%)of 5176 women,comprising226 deliveries come from nulliparous women and 121 come from multiparous women,and 182 births occurred before LEEP were included in the analysis.The obstetric outcomes of 71095 women in multicenter hospitals were set as external comparison.LEEP treatment was associated with an increased risk of adverse obstetric outcomes.LEEP treatment increased risks of PTB(RR 2.604,95% CI 2.093-3.240),severe PTB(RR2.379,95% CI 1.526-3.709)and LBW(RR 1.841,95% CI 1.334-2.541).No evidence of a difference was found in the risk of PROM,PPROM,chorioamnionitis,cesarean section.The risk of PTB was significantly increased when time interval was 0-12 months.The magnitude of risk of PTB was higher for 0-6 months(RR 5.364,95% CI 2.347-12.258)rather than 6-12 months(RR 2.672,95% CI 1.168-6.116).The same trend was shown in LBW.The risk of PROM was significantly increased in 0-6months(RR 6.705,95% CI 2.130-21.099).The HPV infection before LEEP(P = 0.003),TCT abnormal before LEEP(P = 0.036),cone depth>15mm(P = 0.007),and cone radius>10mm(P = 0.029)were confirmed as risk factors of PTB.Through the data analysis of gynecological outpatient,it was found that the pathological positive results after LEEP decreased with the increasing number of colposcopy and LEEP,which indicated that the application of LEEP in clinical had over treatment.A retrospective analysis of 386 domestic literatures on cervical excisional treatment in recent 20 years shows that patients with CIN I-III and CIS are more likely to choose excisional treatment rather than ablation treatment.Conclusion: LEEP treatment increased risks of PTB,severe PTB and LBW.No evidence of a difference was found in the risk of PROM,PPROM,chorioamnionitis and cesarean section.The risk of PTB increased for time interval was 0-12 months,the magnitude is higher for 0-6 months than 6-12 months.The HPV infection before LEEP,TCT abnormal before LEEP,cone depth>15mm and cone radius>10mm further increased the risk of PTB.