Interval from loop electrosurgical excision procedure to pregnancy and pregnancy outcomes

摘要

We congratulate Conner et al on their recent publication on the interval from loop electrosurgical excision procedure (LEEP) to pregnancy and pregnancy outcomes. We want to emphasize the implications of these findings in settings in which see-and-treat strategies are used for primary prevention. In their analysis of 596 women who underwent LEEP between 1996 and 2006, the authors found that spontaneous abortion was significantly associated with a short interval between LEEP and subsequent pregnancy (20 months compared with 31 months, P=.01). Women with an interval of less than 12 months were at significantly increased risk for spontaneous abortion (odds ratio 5.6, 95% CI 2.5-12.7). These findings have important implications for women in low-income and middle-income countries, who accounted for 85% of cervical cancer mortality in 2002. Efforts to improve access to screening in low-income and middle-income countries have shown that screening with visual inspection with acetic acid followed by immediate treatment with cryo-therapy or LEEP can reduce cervical cancer morbidity and mortality.