{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T18:13:40Z","timestamp":1769105620565,"version":"3.49.0"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2012,2,14]],"date-time":"2012-02-14T00:00:00Z","timestamp":1329177600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2012,5]]},"abstract":"<jats:p><jats:italic>Please cite this paper as:<\/jats:italic> Poon L, Savvas M, Zamblera D, Skyfta E, Nicolaides K. Large loop excision of transformation zone and cervical length in the prediction of spontaneous preterm delivery. BJOG 2012;119:692\u2013698.<\/jats:p><jats:p><jats:bold>Objectives\u2002<\/jats:bold> To investigate the association between previous large loop excision of transformation zone (LLETZ) and risk for subsequent spontaneous preterm delivery (sPD) and whether this effect is reflected in the measurement of cervical length at mid\u2010gestation.<\/jats:p><jats:p><jats:bold>Design and setting\u2002<\/jats:bold> A secondary analysis of data from women recruited for clinical trials of interventions to prevent preterm labour.<\/jats:p><jats:p><jats:bold>Population\u2002<\/jats:bold> A total of 26\u2003867 women with singleton pregnancies attending for routine antenatal care.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> Transvaginal sonographic measurement of cervical length was carried out at 20<jats:sup>+0<\/jats:sup> to 24<jats:sup>+6<\/jats:sup>\u2003weeks. Logistic regression analysis was used to determine the significant predictors of sPD among maternal characteristics, obstetric history, previous history of LLETZ and cervical length.<\/jats:p><jats:p><jats:bold>Main outcome measures\u2002<\/jats:bold> Spontaneous preterm delivery.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> In the 473 women who had undergone LLETZ, compared with the 25\u2003772 without a history of LLETZ, the rate of sPD before 34\u2003weeks of gestation was higher (3.4 versus 1.3%, <jats:italic>P\u2003<\/jats:italic>=\u20030.0002) and the median cervical length was shorter (32\u2003mm versus 34\u2003mm, <jats:italic>P\u2003<\/jats:italic>&lt;\u20030.0001). Regression analysis demonstrated that in the prediction of sPD there were significant contributions from racial origin, cigarette smoking, previous preterm delivery and LLETZ and the detection rate of sPD was 29.8%, at a false\u2010positive rate of 10%. However, after addition of cervical length, LLETZ did not remain a significant predictor in the model, which detected 52.6% of sPD, at a false\u2010positive rate of 10%.<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold> LLETZ increases the risk of sPD, even after adjustment for maternal risk factors. The effect of a previous LLETZ on sPD in a subsequent pregnancy is reflected in the measurement of cervical length at mid\u2010gestation.<\/jats:p>","DOI":"10.1111\/j.1471-0528.2011.03203.x","type":"journal-article","created":{"date-parts":[[2012,2,14]],"date-time":"2012-02-14T10:04:30Z","timestamp":1329213870000},"page":"692-698","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":53,"title":["Large loop excision of transformation zone and cervical length in the prediction of spontaneous preterm delivery"],"prefix":"10.1111","volume":"119","author":[{"given":"LCY","family":"Poon","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Savvas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D","family":"Zamblera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E","family":"Skyfta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"KH","family":"Nicolaides","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,2,14]]},"reference":[{"key":"e_1_2_7_2_2","first-page":"CD001318","article-title":"Surgery for cervical intraepithelial neoplasia","volume":"2","author":"Martin\u2010Hirsch P","year":"2000","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(99)00162-9"},{"key":"e_1_2_7_4_2","first-page":"80","article-title":"Pattern of treatment failure following laser for cervical intraepithelial neoplasia: implications for follow\u2010up protocol","volume":"78","author":"Paraskevaidis E","year":"1991","journal-title":"Obstet Gynecol"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1438.1999.99066.x"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)08295-5"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68181-6"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.02.004"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a1284"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181d068a3"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199602293340904"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1998.12050312.x"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.2773"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5333"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa067815"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16351-4"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinchem\/39.4.561"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(00)70240-7"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/pd.2662"},{"key":"e_1_2_7_20_2","first-page":"1","article-title":"Infant mortality statistics from the 2005 period linked birth\/infant death data set","volume":"57","author":"Mathews TJ","year":"2008","journal-title":"Natl Vital Stat Rep"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.earlhumdev.2007.09.003"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-04-0918"},{"key":"e_1_2_7_23_2","volume-title":"Racial\/Ethnic Patterns of Cancer in the United States 1988\u20131992","author":"Miller BA","year":"1996"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(98)00386-X"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181b5cba3"},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000192169.44775.76"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7682"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.06.087"},{"key":"e_1_2_7_29_2","first-page":"909","article-title":"Cervical length screening in patients who have undergone loop electrosurgical excision procedure","volume":"53","author":"Parikh R","year":"2008","journal-title":"J Reprod Med"},{"key":"e_1_2_7_30_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.17.2100"},{"key":"e_1_2_7_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/0028-2243(92)90212-H"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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