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Both loop electrode excision procedures (LEEP) and vaginal infections have been associated with an increased risk for preterm birth. Changes in the physiologic mucosal barrier of the cervix after a LEEP may alter the susceptibility to ascending infection and inflammation during pregnancy. This study is designed to estimate whether a history LEEP and a vaginal infection during pregnancy together amplify the risk for preterm birth.
A retrospective cohort study of women who underwent Pap screening and did or did not undergo LEEP was identified from a surgical pathology database. Medical and obstetric history was obtained by phone interview and review of medical records. Women who underwent LEEP (n=616) were compared to those who did not (n=1839). The index pregnancy was defined as the first pregnancy after LEEP which progressed beyond 20 weeks of gestation. Baseline maternal characteristics were compared using chi-square and student t-tests as appropriate. Univariable analysis was used to estimate the risk of preterm birth at < 37 and <32 weeks in study groups. Vaginal infections including bacterial vaginosis (BV), Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), and trichomonas were assessed. The association between LEEP and preterm birth was analyzed stratified by the presence or absence of each infection. Logistic regression was then used to model the effect modification of various infections on the association between LEEP and preterm birth, adjusting for confounding variables.
Women who underwent LEEP were significantly older and more likely to smoke but less likely to be black than those who did not have LEEP. There was no significant increase in preterm birth at <37 or <32 weeks in women who underwent LEEP compared to controls and there was no significant interaction between LEEP and vaginal infections for risk of preterm birth at <37 weeks (table).
In women who have a history of LEEP, vaginal infection during pregnancy does not amplify risk for preterm delivery. Further, LEEP does not independently increase the risk for prematurity.