Effect of cervical loop electrosurgical excision procedure in treating high-grade squamous intraepithelial lesion and its impact on pregnancy outcomes

  Objective  To investigate the clinical effect of loop electrosurgical excision procedure (LEEP) in the treatment of high-grade squamous intraepithelial lesion (HSIL) and its effect on the pregnancy outcomes.

  Methods  A total of 308 patients with HSIL who had fertility needs and treated with cervical LEEP in our hospital were enrolled in the observation group, and 100 female patients who admitted for other reasons and had no history of cervical LEEP surgery were enrolled as control group by randomly draw method. Patients of both groups received regular follow-up. Complete resection of the lesion, residual lesions and recurrence was recorded in the observation group. The natural pregnancy, the occurrence of adverse pregnancy events during pregnancy, the mode and the outcomes of delivery were compared between the two groups.

  Results  Out of 308 HSIL patients, the lesions of 284 patients were completely resected, with the residual rate of 3.90%, the positive margin rate of 16.56%, and the recurrence rate of 3.57%. There were significant differences in the residual and recurrence rates between margin-negative and positive patients (P < 0.05). There were no statistically significant differences between the observation group and the control group in the first successful pregnancy rate (95.80%vs. 92.00%) and the initial birth rate (91.63% vs. 86.96%) (P>0.05). There were no significant differences in the incidences of abortion, embryonic cessation, and occurrence rate of abortion, premature rupture of membranes, premature delivery and low birth weight caused by other reasons between two groups(P>0.05), but the proportion of patients with cesarean section in the observation group was significantly higher than that in the control group(P < 0.05). The area under the receiver operating characteristic(ROC) curve of interval from postoperative LEEP to successful pregnancy was 0.83, which had good predictive value in preterm birth, with an 83.40%sensitivity and a 67.70%specificity, and 13.70 of optimal cut value. The incidence of preterm birth was significantly lower in pregnant women with interval from postoperative LEEP to successful pregnancy ≥13.70 months than those < 13.70 months(P < 0.05).

  Conclusion  Patients with HSIL have residual lesion and recurrence after LEEP treatment, especially for margin-positive patients. Cervical LEEP operation has no significant effect on fertility and pregnancy outcomes in women with fertility needs. However, short interval between postoperation and pregnancy increase the risk of preterm birth.