Loop Electrosurgical Procedure (LEEP) and the Risk of Premature Labor.

Abnormal Pap smear can be classified as low grade disease or high grade disease or cancer of the cervix. The treatment of the low grade disease may involve observation with Pap smears or freezing of the cervix. The high grade diseases are usually treated with removal of the affected area of the cervix by LEEP (Loop Electrosurgical Procedure). The treatment of cancer of the cervix is radical hysterectomy depending on the stage of the disease.

The benefit of the LEEP procedure in the treatment of precancerous disease of the cervix is that it removes the diseased cervix which is examined by a pathologist to determine the severity and the extent of the disease.

I had a patient who had severe dyspalsia on the cervix for which she had LEEP procedure. She got pregnant. At 13 weeks, I discussed cervical cerclage with her becasue of her short cervix. She had to see another physician because of insurance issues. The new physician refused to place the stich in the cervix. At 24 weeks she went into premature labour and had to stay off work throughout the pregnancy.

It is therefore interesting that a recent study in Danish pregnant women looking at the relationship between previous LEEP procedure and subsequent risk of preterm labor showed that women who had LEEP procedure had 2x chance of having premature labor.

If you have had LEEP procedure, you should let your obstetrician or midwife know about it. Your caregiver may measure the length of your cervix in early pregnancy with ultrasound to determine whether your cervix needs to be stitched or not. If your cervix is long enough to hold the baby, you may still have your baby early and hence you need to be followed up closely.

Reference:
Acta Obstet Gynecol Scand. 2007; 86(5):596-603

Cervical Cancer Vaccine May Prevent Precancerous Changes on the Cervix

An article published in the May 10th New England Journal of Medicine showed that young women not infected with Human Papilloma Virus HPV 16 and 18 who were vaccinated with the Gardasil vaccine had a lower occurrence of the high grade precancerous diseases on the cervix than those who were vaccinated with placebo.

The study was done on 12,167 women aged 15-26 years who had not been previously infected with the HPV. Thus the vaccine, if given to young women who have not already been exposed to the Human Papilloma Virus, is effective in preventing cervical dysplasia in women that will be apparent within years rather than decades.

"Human papillomavirus types 16 (HPV-16) and 18 (HPV-18) cause approximately 70% of cervical cancers worldwide,"

Laura A. Koutsky, PhD, from the University of Washington in Seattle, and colleagues from the FUTURE II study group.

Reference:N Engl J Med. 2007;356:1915-1917.