589: Loop electrical excision procedure (LEEP) and the risk of infectious delivery complications

Loop electrical excision procedure(LEEP) has been linked to an increased risk of preterm delivery. The mechanism for this is not understood, and may result from an alteration in cervical function permitting ascending microbial invasion. We sought to estimate if women exposed to LEEP had increased rates of infectious complications of pregnancy, such as chorioamnionitis and postpartum endometritis. A retrospective cohort study was performed at 12 centers comparing women with a LEEP prior to delivery with women who did not have a LEEP prior for rates of chorioamnionitis, defined as intrapartum fever with antibiotic administration, and postpartum infectious complications. Patients exposed to LEEP were identified by review of pathology records from 1996-2006 and contacted by phone to request enrollment. A phone interview was then completed and obstetric records predating and postdating the LEEP were obtained. Control subjects were then identified by matching age +/− 5yrs, hospital, and year of recorded pap smear. Women were excluded if they did not have any pregnancies beyond 20wks gestation following LEEP or pap smear. Univariable followed by multivariable logistic regression analyses to control for confounders were performed. Of 1613 women meeting inclusion criteria, 573 (35.5%) had a LEEP procedure prior to delivery. Women with a LEEP were more likely to be older and smoke, but less likely to be diagnosed with a sexually transmitted infection (STI) or bacterial vaginosis (BV) during pregnancy. The median gestation(wks) at delivery for both groups was 39 (37-40). Women exposed to LEEP prior to delivery had lower rates of chorioamnionitis (23 [4.0%] vs 81 [7.8%], aOR 0.40 [0.23,0.69]), after adjusting for age, race, antenatal BV and STIs, and GBS status. They also had lower rates of endometritis and postpartum fever, though these differences did not reach statistical significance. In this study, women exposed to LEEP prior to pregnancy had a significantly lower rate of chorioamnionitis. If LEEP is associated with preterm birth, an infectious mechanism may not be in the pathway. Tabled 1