The effect of cervical loop electrosurgical excision on subsequent pregnancy outcome: North American experience

OBJECTIVE: Our purpose was to determine pregnancy outcome and parturition in women who were treatedby loop electrosurgical excision for squamous intraepithelial lesions. STUDY DESIGN: A series of 574 consecutive women of reproductive age (15 to 44 years old) were treated by loop electroexcision for low- and high-grade squamous intraepithelial lesions. The incidence of pregnancies was determined in these women within a 3-year period after therapy by comparing the “observed” number of pregnancies with the “expected” number of pregnancies in the study population, assumign that fertility rates in these women were the same as in the untreated general female population. Pregnancy outcome was correlated in the 53 women who were delivered of an infant with the posttreatment appearance of the cervix and birth weight with maternal smoking. RESULTS: The incidence of pregnancy in the study population was 8.5 per 100 woman years compared with 7.4 per 100 woman years in the untreated central population. Fifty-three women had 54 pregnancies, of which 46 (84%) were live births either at term (40) or between 37 and 39 weeks of gestation (6), and three patients are at present at 24, 34, and 36 weeks of gestation. There were two stillbirths and three first-trimester spontaneous abortions. Premature delivery was not observed. External os stenosis (one case), shortening of the cervix (one case), and repeat electroexcision (four cases) had no adverse effect on pregnancy and parturition. Smoking ≥ 10 cigarettes per day before and during pregnancy, rather than loop electrosurgical excision per se, was associated with lower-birth-weight babies than those of nonsmokers (p< 0.01). CONCLUSION: Loop electrosurgical excision to a maximum depth of 1.5 cm and a mean frontal diameter of 1.8 cm does not appear to have adverse effects on subsequent pregnancy outcome and parturition.