1. For women with cervical intraepithelial neoplasia grade 2 (CIN2), the risk of preterm birth was similar for those who underwent active surveillance compared to immediate loop electrosurgical excision procedure (LEEP)

2. The risk of preterm birth was greater for those who underwent delayed LEEP compared to immediate LEEP. 

Evidence Rating Level: 2 (Good)

Cervical intraepithelial neoplasia grade 2 (CIN2) is typically managed via surgical excision. 50-60% of CIN2 cases regress spontaneously within 2 years; therefore, managing all cases with surgical excision may be over-treatment. In addition, surgical treatment is associated with an increased risk of future obstetric complications, including preterm birth and preterm premature rupture of membranes. In this cohort study, researchers aimed to compare the risk of pre-term birth between women with CIN2 undergoing active surveillance vs. immediate loop electrosurgical excision procedure (LEEP). 10,537 Danish women with CIN2 and singleton births were included in this study. 42% underwent active surveillance, while 58% were managed via immediate LEEP. 8.2% of overall births were preterm. The risk of preterm birth was similar between active surveillance and immediate LEEP (RR, 1.03; 95% CI, 0.90-1.18). For women who underwent delayed LEEP after a period of active surveillance, the risk of preterm birth was greater compared to women treated with immediate LEEP (RR, 1.29; 95% CI, 1.08-1.55). A limitation of this study is that the authors lacked information on some confounding variables that could impact the risk of preterm birth, such as socioeconomic status. Overall, this study demonstrates that for women with CIN2, the risk of preterm birth was similar for those who underwent active surveillance compared to LEEP, while the risk of preterm birth was greater for those who underwent delayed LEEP compared to immediate LEEP. 

Click to read the study in JAMA Network Open

Image: PD

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