title: Risk of cesarean delivery after loop electrosurgical excision procedure.
abstract: OBJECTIVE
  To estimate whether previous loop electrosurgical excision procedure (LEEP) affects the risk of cesarean delivery.
  
  
  METHODS
  A secondary analysis of a multicenter retrospective cohort study was performed. Women who underwent a prior LEEP were compared with two unexposed cohorts: 1) women with prior screening cervical cytology only; and 2) women with prior cervical punch biopsy. The pregnancy evaluated in this analysis was the first pregnancy of a duration more than 20 weeks of gestation after the identifying cervical procedure. Stratified and multivariable logistic regression analyses were used to control for confounding.
  
  
  RESULTS
  Five hundred ninety-eight women with prior LEEP, 588 women with screening cytology only, and 552 women with cervical biopsy were included in this study. After adjusting for relevant confounders, similar rates of cesarean delivery were seen in women with prior LEEP (31.6%) and women with prior cervical cytology only (29.3%, adjusted odds ratio [OR] 1.06, 95% confidence interval [CI] 0.79-1.41). Likewise, no differences were found in rates of cesarean delivery when women with prior LEEP were compared with those with a prior punch biopsy (29.0%, adjusted OR 0.99, 95% CI 0.74-1.33). Among women who had a cesarean delivery, arrest of labor was the indication for cesarean delivery in a similar proportion of women in the groups (LEEP compared with cytology only, P=.12; LEEP compared with biopsy, P=.50). Loop electrosurgical excision procedure specimen size did not vary by delivery mode. Length of time between LEEP and subsequent pregnancy also did not influence delivery mode.
  
  
  CONCLUSIONS
  Loop electrosurgical excision procedure does not affect mode of delivery in the subsequent pregnancy.
  
  
  METHODS
  II.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri 63110, USA. FreyH@wudosis.wustl.edu.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Frey
authors.forename: Molly J
authors.initials: MJ
authors.lastname: Stout
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Odibo
authors.forename: David M
authors.initials: DM
authors.lastname: Stamilio
authors.forename: Alison G
authors.initials: AG
authors.lastname: Cahill
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Roehl
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D004598:Electrosurgery / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000601:surgery; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000601:surgery