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Studies suggest that prior loop electrosurgical excisional procedure (LEEP) is associated with cervical stenosis. Cervical stenosis may interfere with physiologic cervical ripening, thus preventing spontaneous onset of labor. Our objective is to estimate if LEEP increases the risk of a post-term labor induction.
A retrospective cohort study of women who did or did not have a LEEP (1996-2001) in 12 centers and had a subsequent pregnancy with delivery >20 weeks gestation. Women with a LEEP were compared to women with no cervical surgery prior to delivery. Control subjects were identified by matching age +/− 5 years, hospital, and year of recorded pap smear based on pathology records. Women with a subsequent preterm delivery or no pregnancies beyond 20 weeks post-LEEP were excluded. The primary outcome was post-term labor induction. For this study, post-term was defined as ≥40 weeks. Other reasons for labor induction and cesarean delivery were assessed as secondary outcomes. Multivariable logistic regression analysis was used to control for confounders.
Among 1520 women meeting the inclusion criteria, 496(32.6%) had a history of LEEP and 1024(67.4%) did not have a LEEP prior to their compared pregnancy. Women with a LEEP were more likely to be older, Caucasian, and smoke tobacco. Women who had a LEEP did not have an increased risk for a post-term labor induction (8.5 vs. 7.3%, p-value=0.99; adjusted odds ratio[aOR] 1.47 95% CI 0.62-3.59). There was a nearly significant increase in the rate of labor induction for any indication (36.5% vs. 31.2%, p=0.06;[aOR]1.09, 95% CI 0.82-1.46) and in the rate of cesarean delivery (28.9% vs. 24.5%, p-value=0.08;[aOR] 1.17 95% CI 0.86-1.59) in women with a history of LEEP.
LEEP is not associated with an increased risk for post-term labor induction in the subsequent pregnancy.