Date of Graduation

8-14-2010

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Dr. Mark Pedemonte, MD

Second Advisor

Annjanette Sommers MS, PAC

Third Advisor

Rob Rosenow PharmD, OD

Abstract

Background: Cervical intraepithelial neoplasia (CIN) can be a precursor to the development of invasive cervical cancer. There are two ways to approach the treatment of CIN, observation or immediate treatment. For women with CIN1, most often observation is the best choice. Women diagnosed with CIN2 or CIN3 typically undergo immediate treatment, due to the increased likelihood of progression. LEEP is currently the procedure of choice, and its association with preterm delivery has been a topic of debate. Many studies have been done analyzing the LEEP in an attempt to investigate the association, and while this is a promising tool in the treatment of cervical cancer, more research needs to be done to reach a definitive conclusion.

Methods: A comprehensive search of the medical literature published within the last five years was conducted using MEDLINE, CINAHL, and EBM Multifile. Search terms used were: cervical intraepithelial neoplasia, loop electrosurgical excision procedure, and pregnancy complications. Web of Science was used in a secondary search to locate articles of interest from the references of the included articles. Each article was filtered based on strict inclusion and exclusion criteria, and then critically appraised. The validity of each article was assessed using the criteria located in Table I.

Results: A total of seven articles were critically appraised. These articles are addressed in Table II. After the appraisal, one article was eliminated due to receiving a validity score less than 3. In Acharya et al the rate of preterm delivery was observed at 9/79 (11.4%) in the study group and 17/158 (10.8%) in the control group. In Samson et al the rates of preterm delivery were 44/558 (7.9%) and 14/558 (2.5%) in the study and control groups respectively. In Nohr et al (2007) the rate of preterm delivery following LEEP was identified at 6.6%, with an adjusted odds ratio of 1.8 and 95% CI of 1.1-2.9. The preterm delivery rate among the comparison group was 3.5% with an OR of 1.0. In Michelin et al the rate of preterm delivery was 1/18 (5.5%). The comparison group was those who were submitted to cold knife conization, in which the preterm delivery rate was 4/17 (23.5%). In Nohr et al 2009 the preterm delivery rate was 530/8180 (6.5%) with an OR of 2.11 and 95% CI of 1.9-2.3. The rate of preterm delivery after no procedure was 17,106/510,841 (3.3%) with an OR of 1.0. In Jakobsson et al the rate of preterm delivery after LEEP was 75/624 (12%), with an OR of 2.61.

Conclusion: Treatment of cervical intraepithelial neoplasia with the LEEP does appear to be associated with and increased risk of preterm delivery, ranging from two to three and a half times greater than that of the general population. Increase in cone height of removed tissue also reflects a greater risk for preterm delivery. More research needs to be done in order to clarify whether the presence of cervical neoplasia alone is a risk factor for adverse outcomes on future pregnancy.

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