Low-depth conization in young patients treated by LEEP: impact on pregnancy outcomes

Objective Purpose of the study was to evaluate whether the removal of cones deep <10 mm both therapeutic and safe in terms of fertility and pregnancy outcome. Methods Between January 2000 and January 2009 we collected data of 761 patients treated by LEEP for cervical intraepithelial neoplasia (CIN) in Gynecological Unit of Pisa University Hospital, Tuscany (Italy). Among that group we enrolled, in a prospective study, 156 patients that became pregnant after treatment to analyse the impact of ‘low-depth conization’ (median depth of removed tissue 8 mm) on obstetrical outcomes. They were evaluated for preterm births and caesarean sections during labor and compared to general population (19 813 patients) who delivered in the same period in our Gynecological Unit; we also compared the rate of miscarriages to the average Tuscany rate. ª 2016 The Authors. BJOG An International Journal of Obstetrics and Gynaecology ª 2016 RCOG 15 Stream 3 – Oncology and colposcopy Median depth of excision and therapeutic efficacy in terms of recurrences were analysed and compared to literature data. All patients were submitted to follow-up procedures with HPV test, colposcopy and cytology every 6 months in the first 2 years and then annualy. Statistical analysis was performed by Fisher’s exact test, a P < 0.05 value was considered as significant. Results The median age of patients was 28 years and the median depth of the cones excised was 8 mm. Three women (2.17%) delivered before term (preterm delivery in general population 8.31%, P = 0.0512), 14 women (10.14%) delivered by caesarean section in labor (rate of caesarean sections in general population 11.5% P = 0.8470), 17 women (10.8%) had a miscarriage (general pupulation 12.7%, P = 0.8596). Seven patients (4.48%) developed a recurrence (rate of recurrences according to the literature data 3.4%, P = 0.7700). Statistical analysis has shown no significant increase of obstetrical complications Conclusion ‘Low-depth conization’ when performed in young women is comparable to the standard LEEP technique for CIN treatment. Our results confirm the same therapeutic efficacy compared to largest excisions. Statistical analysis also confirmed the safety in terms of fertility and pregnancy outcomes with no increase of obstetrical complications