Cervical length regeneration after large loop electroexcision

Introduction

Loop electro-excisional procedure (LEEP) is indicated if high-risk cervical intraepithelial neoplasia is diagnosed to remove the premalignant area of the cervix, thereby excluding cervical cancer progression. Unfortunately, LEEP increases preterm labor risk through mechanical cervical defect and an alteration of the cervical barrier. One of the least studied factors are cervical length (CL) regeneration and its subsequent influence on the pregnancy outcome. Some data state that cervical regeneration is completed after six months and is 83.4% (±10.8%) from the initial length.

Aim
The aim of the present study is to calculate the CL regeneration three to six months after the LEEP procedure.

Methods
A prospective cohort study was performed in Riga Maternity hospital from 2021-2022.
12 women of reproductive age who were scheduled for LEEP were included in the study. CL measurements were carried out with a predefined ultrasound measurement technique by one operator before LEEP and 3 and 6 months after. Cone length (CoL) was measured right after LEEP with an electronic caliper. CL regeneration was calculated as CoL minus the cervical deficit at 3/6 months divided by CoL and multiplied by 100. CL regeneration after 3/6 months was compared with Paired sample T-test.

Results
Out of 12 patients, 10 women had all the necessary measurements. The mean women’s age was 30.14 years (26-40 years). The mean excisional cone depth was 11.26 mm (SD +/- 4.2). CL regeneration after 3 months was 48.8% (SD +/- 13.14) and after 6 months 61.4% (SD +/- 12.3). CL after 6 months was increased by 12.5 % when compared with 3 months (CI 95% 4.57-20.5) with statistical significance (p<0.05).

Conclusions

CL regeneration is the most marked during the first three months and continues at least until six months after LEEP. More research is needed to better understand cervical regeneration over a longer period.