Loop electrosurgical excision procedure and risk of preterm birth: a systematic review and meta-analysis.
نویسندگان
چکیده
OBJECTIVE To assess whether loop electrosurgical excision procedure (LEEP) increases the risk for preterm birth before 37 weeks of gestation and clarify whether the increased risk for preterm birth is attributable to the procedure itself or to risk factors associated with cervical dysplasia. DATA SOURCES Two authors performed a search of the relevant data through February 2013 using PubMed, Embase, Scopus, CENTRAL, and ClinicalTrials.gov. METHODS OF STUDY SELECTION We included observational studies that compared rates of preterm birth in women with prior LEEP with women with no history of cervical excision. Nineteen of 559 identified studies met selection criteria. TABULATION, INTEGRATION, AND RESULTS We compared women with a history of LEEP with two unexposed groups without a history of cervical excision: 1) women with an unknown or no history of cervical dysplasia; and 2) women with a history of cervical dysplasia but no cervical excision. The primary outcome was preterm birth before 37 weeks of gestation. Secondary outcomes were preterm birth before 34 weeks of gestation, spontaneous preterm birth, preterm premature rupture of membranes, and perinatal mortality. DerSimonian-Laird random effects models were used. We assessed heterogeneity between studies using the Q and I tests. Stratified analyses and metaregression were performed to assess confounding. Nineteen studies were included with a total of 6,589 patients with a history of LEEP and 1,415,015 without. Overall, LEEP was associated with an increased risk of preterm birth before 37 weeks of gestation (pooled relative risk 1.61, 95% confidence interval [CI] 1.35-1.92). However, no increased risk was found when women with a history of LEEP were compared with women with a history cervical dysplasia but no cervical excision (pooled relative risk 1.08, 95% CI 0.88-1.33). CONCLUSION Women with a history of LEEP have similar risk of preterm birth when compared with women with prior dysplasia but no cervical excision. Common risk factors for both preterm birth and dysplasia likely explain findings of association between LEEP and preterm birth, but LEEP itself may not be an independent risk factor for preterm birth.
منابع مشابه
Interval from loop electrosurgical excision procedure to pregnancy and pregnancy outcomes.
OBJECTIVE Previous studies have shown mixed results for pregnancy outcomes after loop electrosurgical excision procedure (LEEP); however, evidence is lacking regarding the pregnancy outcome of spontaneous abortion with respect to time elapsed from LEEP to pregnancy. We investigated risks of spontaneous abortion and preterm birth as they relate to time elapsed from LEEP to pregnancy. METHODS A...
متن کاملLoop electrosurgical excision procedure and the risk for preterm delivery.
OBJECTIVE To estimate whether the severity of cervical intraepithelial neoplasia (CIN) and the loop electrosurgical excision procedure (LEEP) increase the risk for preterm delivery, and to evaluate the role of repeat LEEP and time interval since LEEP. METHODS This was a retrospective register-based study from Finland from 1997 to 2009. We linked Hospital Discharge Register and Finnish Medical...
متن کاملPerinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis
OBJECTIVE To assess the relative risk of perinatal mortality, severe preterm delivery, and low birth weight associated with previous treatment for precursors of cervical cancer. DATA SOURCES Medline and Embase citation tracking from January 1960 to December 2007. Selection criteria Eligible studies had data on severe pregnancy outcomes for women with and without previous treatment for cervica...
متن کاملMaternal Anemia and Pregnancy outcomes: a Systematic Review and Meta-Analysis
Background The aim of this study was to determine the relationship between maternal anemia during pregnancy and pregnancy outcomes. Materials and Methods This systematic review was conducted in domestic (Sid, Iran.doc, Iran medex and Magiran) and international (PubMed, Science Direct, Cochrane, Medline, Web of Science, Scopus, Springer, Embase, Google scholar) databases from January 1, 1990 t...
متن کاملThe Effect of Lifestyle Intervention on Pregnancy and Birth Outcomes on Obese Infertile Women: A Systematic Review and Meta-Analysis
Background: Obesity has been associated to negative effects on natural fertility and a worse prognosis when assisted reproduction techniques are performed. Patients attending for fertility treatments are often advised to optimize their weights to improve outcomes. There are doubts about how effective are weight-loss interventions for improving fertility in women who are overweight or obese. Mat...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Obstetrics and gynecology
دوره 115 3 شماره
صفحات -
تاریخ انتشار 2010