Early and late pregnancy outcomes in women treated with cold-coagulation versus LLETZ cervical treatment for cervical intraepithelial neoplasia; a retrospective cohort study
To compare the pregnancy outcomes between women who were treated with cold-coagulation versus large loop excision of the transformation zone (LLETZ) for cervical intraepithelial neoplasia.
This was a retrospective cohort study of women who had a single cervical treatment between 2010 and 2011. We identified those women who had a singleton pregnancy subsequent to their cervical treatment until September 2017. Women with previous cervical treatment, previous miscarriage or preterm delivery were excluded.
We identified 86 women with a pregnancy after LLETZ treatment and 75 women after cold coagulation. Those who had LLETZ when compared to cold coagulation miscarried more often in the first trimester (33.7 vs 17.3%; p = 0.01) than in the second trimester. In women with LLETZ this effect of increased early miscarriage was shown to be prolonged and to persist up to 17 months after excision. Women with LLETZ when compared to cold coagulation had higher spontaneous preterm birth rates (8.9 vs 6.7%) even though the difference was non significant, with the earliest spontaneous preterm birth occurring at 32 weeks and 34 weeks, respectively.
We found that women who received LLETZ treatment when compared to cold coagulation had higher spontaneous preterm birth rates in their subsequent pregnancy and miscarried more frequently in the first trimester, and demonstrated an increased early miscarriage risk that persisted for more than a year after excisional treatment.
KeywordsCold coagulation LLETZ CIN Miscarriage Preterm birth
We would like to thank Christopher Weston, data analyst of Medway electronic database at the Shrewsbury and Telford Hospital NHS Trust for his contribution and support in the data collection for this study. We would also like to thank Mrs. Tzavara Chara, biostatistician from the Department of Hygiene, Epidemiology and Medical Statistics, at the Medical School of University of Athens in Greece, for her support in the statistical analyses of data.
D. Papoutsis: Protocol/project development, data collection and data management, data analysis, manuscript writing and editing. M. Underwood: Protocol/project development, data collection and data management, manuscript writing and editing. W. Parry-Smith: Protocol/project development, data collection and data management, manuscript writing and editing. J. Panikkar: Protocol/project development, manuscript writing/editing.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving Human Participants and/or Animals: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Our study was a retrospective study, and for this type of study formal consent is not required.
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