How LEEP Affects Pregnancy and Childbirth

by Brian M. Williams

Pregnancy After LEEPIf your pap smear or colposcopy shows high-risk, abnormal cervical cells, your doctor might suggest removing them with a procedure called LEEP.

Your first concern might be around future pregnancies. LEEP affects pregnancy and birth on some level. Women hear tales of sterility, miscarriage, and preterm labor when researching the procedure. We'll try to make it less scary and easier to understand.

What is LEEP?

LEEP, which stands for Loop Electosurgical Excision Procedure, is used to treat cervical dysplasia. A LEEP uses an electrically charged wire loop to remove cervical tissue. It's done under local anesthesia and usually performed in the doctor's office or on an outpatient basis in the hospital.

Cervical dysplasia or abnormal cells at a high risk of becoming cancerous are often first detected on a pap smear. It's why having a yearly exam is so important.

How Often Do You Need a Pap Smear?

A few years ago, the relationship between invasive cervical procedures and later problems with childbirth was recognized. It was also found that most women under 21 spontaneously revert to a normal pap smear and clear HPV viruses that are associated with cervical cancer without any treatment.

Experts decided that the risk of the pap leading to an unnecessary procedure leading to childbirth problems outweigh the benefits of the pap, so women under 21 are not encouraged to have a pap.

The US Preventative Task Force, the group that makes guidelines for medical practices recommendations, released a bulletin on March 12, 2012 suggesting the following schedule:

Under Age 21: no pap smear, no HPV testing
Age 21-29: Pap every 3 years
Age 30-65: Pap + HPV every 5 years

If you have symptoms like abnormal bleeding or signs of infections, check with your healthcare provider about appropriate screening and follow-up.

Pregnancy Complication Following LEEP

LEEP has been associated with an increased risk of future pregnancy problems, according to The American Congress of Obstetricians and Gynecologists (ACOG).

They state that most women don't experience pregnancy difficulties following a LEEP, but there's a small chance of having a premature or low birth weight baby. In rare cases, the LEEP procedure can cause cervical incompetence or problems dilating during labor.

Recent research indicates that LEEP doesn't raise your risk of preterm birth and low birth weights, so that is some good news.

Preterm Birth

LEEP can shorten the cervix. For a few women this can increase the risk of preterm labor or an incompetent cervix.

Cervical Scarring or Stiffness

Stenosis or cervical scarring can cause stiffness that makes opening the cervix difficult or painful. Stenosis occurs in less than 5 percent of the women who have had LEEP. In severe cases, it may prevent sperm from entering through the cervix.

Once diagnosed, it can be corrected with gentle dilation. If you've had LEEP, discuss this possible complication and its resolution with your midwife or doctor.

Infertility

While a rare complication, some women are not able to get pregnant after LEEP. Experts aren't sure why yet, but do offer one explanation.

The loss of cervical tissue can affect conception by decreasing cervical mucus. These secretion provide nutrients and fluid that help the sperm reach the egg.

If you're having problems getting pregnant, you're doctor might suggest Intra-uterine insemination to get the sperm past the cervix and up into your womb.

Questions to Ask Your Doctor Before LEEP

• Could these abnormal cells resolve on their own?
• Is LEEP the only treatment option I have?
• How to you think a LEEP will affect a future pregnancy?
• How long will it take my cervix to heal?
• How long should I wait before having sex?
• After the LEEP, how long should we wait to try to get pregnant?
• Will you provide notes about my LEEP to share with my OB/GYN?


Medical references:
- Screening for Cervical Cancer. Release Date: March 2012.
- Macones G, et al "Pregnancy after LEEP: results of a multicenter study." Society for Maternal-Fetal Medicine. 2012; Abstract 5.