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Labor

Poster Session 1

(251) LEEPs and Cones: Do they impact labor induction duration?

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Cervical excision via loop electrocautery procedure (LEEP) or cold knife cone (CKC) is associated with subsequent preterm birth, but these procedures may also lead to cervical scarring and stenosis. We aimed to evaluate how the post-excision healed cervix functions during labor in response to induction.

Study Design: This is a retrospective cohort study of pregnant patients being induced at a single academic center between 7/2013 and 10/2018. We compared duration of the 1st stage of labor (from induction start to full dilation) among patients with and without prior cervical excision (via LEEP or CKC). We excluded those with multiple gestation, spontaneous labor, or urgent delivery before full dilation. The primary outcome was time from induction initiation to full dilation. Data were analyzed using Chi square, Fischer’s exact, Mann-Whitney-U test, and non-parametric signed rank test.

Results:

A total of 228 patients with history of cervical excision (223 LEEPs, 6 CKCs) and 5995 patients without such history were studied. Patients with excision history were more likely to be White (82% vs 69%), to have a short cervix (4.4% vs 1.3%), and to have less favorable starting cervical dilation (2.25 cm [IQR 1-3.5] vs 2.5 cm [IQR 1-4]); clinical features (such as median parity) and obstetrical outcomes (such as median blood loss) were similar between groups. Median duration of 1st stage of labor was longer among patients with vs without excision history (Figure: 624 min [IQR 439-935] vs 600 min [IQR 385-907], pvalue < 0.001).

Conclusion: Patients with a history of cervical excision experienced a longer duration of the first stage of labor compared to those without excision history. Future studies, such as in the setting of induction failure, may help further explore the differential impact of cervical excision on subsequent labor, possibly informing individualized induction guidelines for these patients.