Complications of loop electrosurgical excision procedure for cervical neoplasia: a prospective study.

OBJECTIVES: To evaluate the complications following loop electrosurgical excision procedure (LEEP) for diagnosis and treatment of cervical neoplasia. MATERIAL AND METHOD: Descriptive cross sectional study in patients with abnormal cervical cytology who underwent LEEP at Chiang Mai University Hospital between November 2004 and July 2005 were prospectively evaluated for complications. RESULTS: During the study periods, 206 patients underwent cervical loop excision for a total of 226 procedures. The mean age of the patients was 41 years (range, 26-72 years). Sixty (29.1%) women were menopausal. The most common abnormal cervical cytology was HSIL (56.3%) followed by LSIL (12.1%). Twenty-five (11.1%) patients received re-excision for positive margin after the first procedure. Intraoperative hemorrhage occurred in 7.9% of the procedures. Early and late postoperative hemorrhage occurred in 0.4% and 2.6% of the procedures, respectively. Eight (3.5%) had postoperative infections and were cured with oral antibiotics. By logistic regression analysis, there was no significant correlation between age, menopausal status, HIV status, re-excision procedure, final histopathology, cone dimension and the complications of LEEP. CONCLUSION: Loop electrosurgical excision procedure is safe for evaluation and treatment of cervical neoplasia with an acceptable and manageable surgical morbidity.

Steroid contraceptive use and pregnancy outcome.

Contraceptive use in relation to pregnancy outcome was studied in 8,816 births in Chiang Mai, northern Thailand, by examination of newborn infants and interviews with their mothers. Four thousand twenty-three women used no contraception before the index pregnancy, 1,229 used the injectable contraceptive Depo Provera (DMPA), and 3,038 used oral contraceptives prior to or during pregnancy. No differences were observed between these groups with respect to still births, multiple pregnancies, and birthweight. Women who used oral contraceptives had unexpectedly low rates of major defects and may have been affected by self-selection bias, whereas the noncontraceptors had rates similar to other populations. There was a significantly increased association of polysyndactyly among infants of DMPA users relative to the other groups, which was most pronounced in offspring of women under age 30 years, and persisted after exclusion of subjects with a family history or infants with multiple abnormalities. However, in five out of the ten polysyndactyly cases, the last injection of DMPA occurred more than 9 months before conception, and only three cases had definite gestational exposure. The association of chromosomal anomalies was also significantly increased in infants of mothers who used DMPA. The unrelated nature of these defects, the lack of confirmation from other studies, the distant preconceptional exposure to DMPA in many cases, and chance effects due to multiple statistical comparisons make a causal association unlikely. Other birth defects that had been previously reported in some publications to be associated with progestational steroid exposure, such as neural tube defects, heart malformations, and limb reduction defects, were not found in this study.(ABSTRACT TRUNCATED AT 250 WORDS)