Can You Have a LEEP if You are Pregnant?

LEEP is an acronym for a medical procedure called loop extrosurgical excision procedure. It also sometimes called large loop excision of the transformation zone (LLETZ) or loop excision. In this procedure, a small electric wired loop is used to remove tissue cells from a woman’s lower genital part (this includes both the cervix and the vagina). The electricity flowing through the wire causes it to heat up and enables it to work similar to a surgeon’s knife. The tissue cells that are cut during the procedure are intact and undamaged, which makes it a preferable choice when compared to other destructive procedures. In addition, it is also associated with a lower cost and fewer side effects.

Your healthcare provider may recommend a LEEP if there is any abnormality detected in your lower genital tract. Either this abnormality could be detected during a routine Pap smear or it could be a finding from a cervical biopsy.

In cases where there is a suspected abnormality, LEEP is used a diagnostic tool to obtain tissue samples from the cervix or vagina. These samples are then sent for biopsy to confirm the presence of cancer. In some cases, the LEEP may reveal the presence of precancerous cells (cells abnormal but not cancerous) which could be an early indicator of cancer development.

In cases where there is confirmation of abnormal tissue growth, LEEP can be used to treat the condition by removing the concerned cells and allowing healthy cells to grow back in their place.

At your LEEP appointment, you will undress and lie on the exam table as you do for any pelvic exam. Your healthcare provider will use speculum to open up your vagina and expose your cervix. He may then use a colposcope (an instrument like a microscope) to better visualize the internal tissues. The doctor will then use a local anesthetic, so you do not experience pain during the procedure. The LEEP wire will then be inserted through the speculum into the vagina and it will cut through the abnormal tissues. The electric current from the wire will seal the cut blood vessels and so stop the bleeding. Depending upon on amount and location of tissue that needs to be removed as well as the size and shape of the wire used, it may take more than one attempt to get rid of all the abnormal tissues.

LEEP is an invasive procedure that cuts away tissue slices from within the vagina or cervix. This highly unsafe procedure could risk miscarriage and other fetal complications if performed during later stages of pregnancy. However, there are studies that have reported the safety of LEEP when performed during the early stages of pregnancy. In one such study, nine patients safely performed LEEP within 14 weeks of their pregnancy and none of them experienced spontaneous abortion, premature delivery or heavy bleeding after the procedure. In general though, it is advisable to avoid this procedure during pregnancy unless critical.

In case the LEEP was recommended to treat precancerous cell growth, it is advisable to wait until after childbirth to perform this procedure. This is because in most cases precancerous take a long time (months to years) to become actively cancerous. Therefore, the recommended approach would be to keep monitoring the abnormal tissues using colposcopy. Colposcopy is a safe non-invasive procedure in which the healthcare provider places a colposcope (an instrument that has the same function as that of a microscope) at the opening of the vagina to study the tissues within the vagina or cervix.

Even in cases of active cancer, it is not advisable to proceed with LEEP. It is better to consult a gynecologic oncologist and decide on an alternative treatment option that is the safest for the mother and the child.

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Also Read:

• Colposcopy: Indications, Benefits, Procedure, Principles, Complications, Contraindications