[Corrections added after online publication 17 February 2012: E Paraskevaides was changed to E Paraskevaidis in the author list and ‘Unit of Cancer Epidemiology’ was added to the affiliation for M Arbyn].
The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy-related morbidity
Article first published online: 14 FEB 2012
© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 119, Issue 6, pages 685–691, May 2012
How to Cite
Khalid, S., Dimitriou, E., Conroy, R., Paraskevaidis, E., Kyrgiou, M., Harrity, C., Arbyn, M. and Prendiville, W. (2012), The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy-related morbidity. BJOG: An International Journal of Obstetrics & Gynaecology, 119: 685–691. doi: 10.1111/j.1471-0528.2011.03252.x
- Issue published online: 10 APR 2012
- Article first published online: 14 FEB 2012
- Accepted 14 November 2011. Published Online 14 February 2012.
- Cervical intraepithelial neoplasia;
- electrosurgical excision;
- large loop excision of the transformation zone;
- loop electrosurgical excision procedure;
- pregnancy outcomes;
- preterm labour
Please cite this paper as: Khalid S, Dimitriou E, Conroy R, Paraskevaidis E, Kyrgiou M, Harrity C, Arbyn M, Prendiville W. The thickness and volume of LLETZ specimens can predict the relative risk of pregnancy-related morbidity. BJOG 2012;119:685–691.
Objective The aim of this study was to determine if the individual physical characteristics of the extirpated transformation zone after large loop excision of the transformation zone (LLETZ) might predict the relative risk of adverse obstetric outcome, specifically preterm labour (PTL).
Design A retrospective observational study.
Setting University teaching hospital in Dublin (Coombe Women & Infants University Hospital, CWIUH).
Population Women who had LLETZ treatment for cervical intraepithelial neoplasia (CIN) in the colposcopy service between 1999 and 2002, and who subsequently had a pregnancy at the CWIUH.
Methods Case records and histology reports for eligible women were examined. Age, parity, smoking history, pregnancy complications and CIN grade were recorded. Exclusion criteria were age >42 years, previous treatment for CIN, previous premature labour or twin pregnancies. The Student’s t-test, Mann–Whitney U-test, analysis of variants (ANOVA) and logistic regression were employed to analyse the data.
Main outcome measures Gestational age at birth, PTL (i.e. <37 weeks of gestation) and miscarriage rate (<24 weeks of gestation).
Results Out of 1808 women who underwent LLETZ treatment, a total of 353 women were identified who subsequently had a pregnancy at the CWIUH, with 321 being eligible for inclusion in the study. Of these, 76.3% delivered at term, 9.1% delivered at <37 weeks of gestation and 14.6% miscarried at <24 weeks of gestation. There was a three-fold increase in the risk of PTL if the excision volume exceeded 6 cm3 (RR = 3.00; 95% CI 1.45–5.92), or when the thickness of the excised tissue was greater than 12 mm (RR = 2.98; 95% CI 1.27–7.01). The time interval between LLETZ and pregnancy did not appear to have an effect on PTL rates. We found no association between the grade of CIN and the risk of PTL.
Conclusions This study reveals that the thickness and the total volume of the excised transformation zone are associated with an increased risk of PTL. Excisions thicker than 1.2 cm and larger than 6 cm3 carry a three times greater risk for PTL.