PREGNANCY OUTCOME AFTER LARGE LOOP EXCISION OF THE CERVICAL TRANSFORMATION ZONE

OBJECTIVE: Our purpose was to determine whether large loop excision of the cervical transformation zone affects the outcome of pregnancy aft er 20 weeks' gestation. STUDY DESIGN: In a retrospective case control study 40 women who had undergone large loop excision of the cervical t ransformation zone and were subsequently delivered at Dudley Road Hosp ital were identified between January 1989 and January 1992. Eighty con trols were identified and matched for age, parity, and ethnic group fr om women delivered immediately before and after index Gases. Variables included maternal performance in labor and smoking habits and perinat al outcome. Maternal factors analyzed included pregnancy gestation, le ngth of the first and second stages of labor, use of oxytocin, analges ia, mode of delivery, estimated blood loss, whether labor was spontane ous or induced, and if preterm spontaneous rupture of membranes occurr ed. Perinatal outcome measures included whether the infant was livebor n, fetal weight, the presence of fetal abnormalities, and admission to the neonatal unit. RESULTS: Women delivered after large loop excision of the cervical transformation zone had infants of significantly lowe r birth weight than did controls. They were also significantly more li kely to have admitted to smoking on admission. CONCLUSION: Previous st udies investigating pregnancy outcome after local destructive methods of treating cervical intraepithelial neoplasia have been generally rea ssuring. However, in this study women who were delivered after large l oop excision of the cervical transformation zone had significantly sma ller infants. Although this may be related to the characteristics of w omen who have cervical intraepithelial neoplasia (for example, their s moking habits), larger adequately controlled studies should be perform ed before colposcopists can be justified in adopting a liberal attitud e to treating all women with abnormal smears.