653: Risk of cesarean delivery following loop electrosurgical excision procedure (LEEP)

653 Risk of cesarean delivery following loop electrosurgical excision procedure (LEEP) Heather Frey, Molly Stout, Anthony Odibo, David Stamilio, Alison Cahill, Kimberly Roehl, George Macones Washington University in St. Louis, Department of Obstetrics and Gynecology, St. Louis, MO OBJECTIVE: Theoretically, cervical scarring after LEEP could impede cervical dilation leading to increased rates of cesarean delivery. Existing data is conflicting and comes from studies in which cesarean delivery is not the primary outcome of interest. Our aim was to assess whether LEEP therapy for cervical dysplasia is associated with an increase in the risk of cesarean delivery in subsequent pregnancies. STUDY DESIGN: This is a secondary analysis of a multicenter retrospective cohort study. Women with prior LEEP as well as age-matched controls with screening cervical cytology performed the same calendar year were identified from databases of surgical pathology at nine participating hospitals. Trained research nurses contacted the participants by phone and collected information including maternal demographics as well as details regarding all pregnancies both prior to and after the procedure. With informed consent, medical records were obtained from each pregnancy. The pregnancy evaluated in this analysis was the first pregnancy of duration 20 weeks after either LEEP procedure or pap smear. Multivariable analysis was used to estimate the risk of cesarean delivery associated with prior LEEP. RESULTS: 614 women with a prior LEEP and 609 women with a prior pap were included in this study. Prior LEEP was associated with a higher cesarean rate in the subsequent pregnancy (30.8% vs. 25.6%, p 0.04). This difference remained significant after adjusting for parity, infant birthweight 3500g, maternal diabetes and prior cesarean delivery. Subgroup analysis based on gestational age demonstrated that prior LEEP was associated with an increased rate of cesarean delivery in preterm deliveries, and there was a trend towards a similar association in those at term. CONCLUSION: In this cohort study, LEEP was associated with increased rates of cesarean delivery in the subsequent pregnancy particularly in women who delivered preterm. 654 Ultrasound indicated cerclage: Shirodkar vs. McDonald Heather Hume, Andrei Rebarber, Daniel Saltzman, Nathan Fox Mount Sinai School of Medicine, Obstetrics and Gynecology, New York, NY, Carnegie Imaging for Women, Obstetrics and Gynecology, New York, NY OBJECTIVE: To compare the efficacy of Shirodkar to McDonald cerclage in patients undergoing an ultrasound-indicated cerclage. STUDY DESIGN: Historical cohort of all patients undergoing cerclage at one institution in 2005-2010. The primary analysis was in patients who underwent cerclage for the indication of a short cervix on ultrasound (ultrasound-indicated). Outcome measures were gestational age at delivery, delivery 35 weeks, 32 weeks, and PPROM. We analyzed outcomes in all patients, patients with singleton pregnancies, and patients with a singleton pregnancy and a prior preterm birth or second trimester loss. Multiple regression analysis was performed to control for significant variables. RESULTS: Ninety-four patients underwent an ultrasound-indicated cerclage in the study period (61 Shirodkar, 33 McDonald). Shirodkar was associated with later gestational ages at delivery (mean GA at delivery 35.85 / 3.94 vs. 32.72 / 6.04, p 0.004, a higher likelihood of delivering 35 weeks (adjusted OR 3.328, 95% CI 1.087, 10.188) and 32 weeks (adjusted OR 6.635, 95% CI 1.830, 24.066). Shirodkar similarly outperformed McDonald cerclage in all singleton pregnancies, and singleton pregnancies with a prior preterm birth or second trimester loss. CONCLUSION: Compared to the McDonald technique, the Shirodkar technique was more effective in prolonging pregnancy in patients undergoing ultrasound-indicated cerclage.