Departments of Obstetrics and Gynecology and General Internal Medicine, Boston Medical Center/Boston University School of Medicine, and the Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts.
Obstet Gynecol. 2018 Feb;131(2):253-261. doi: 10.1097/AOG.0000000000002446.
To compare obstetric outcomes after failed hysteroscopic and laparoscopic sterilization.
This retrospective cohort study examined pregnancy outcomes including live birth, preterm birth, stillbirth, spontaneous abortion, therapeutic abortion, ectopic pregnancies, and gestational trophoblastic disease using a commercial claims administrative database for the years 2007-2013. We used a Z-test to compare pregnancy outcomes per 100 person-years based on type of sterilization. Cox proportional hazard models controlled for patient age, geographic region, urbanicity, comorbidities, and insurance type.
We evaluated 997 pregnancy outcomes among 817 women from a total of 70,115 women with a history of either hysteroscopic sterilization (n=387 pregnancies/27,724 cases) or laparoscopic sterilization (n=610 pregnancies/42,391 cases). Women undergoing hysteroscopic sterilization were slightly older than, but otherwise similar to, women undergoing laparoscopic sterilization. The most common outcome was live birth, which was more likely after hysteroscopic sterilization compared with laparoscopic sterilization (adjusted hazard ratio 1.32, 95% CI 1.09-1.60). The rate of spontaneous abortion was not statistically significantly different between the two groups. Therapeutic abortion occurred more often after hysteroscopic sterilization (adjusted hazard ratio 1.49, 95% CI 1.10-2.01), whereas ectopic pregnancies occurred less often (adjusted hazard ratio 0.12, 95% CI 0.05-0.29) compared with laparoscopic sterilization.
Hysteroscopic sterilization is associated with higher rates of live birth and lower rates of ectopic pregnancy compared with laparoscopic sterilization. Spontaneous abortion and preterm birth rates were similar in both groups. These data do not support an adverse effect of hysteroscopic sterilization on subsequent pregnancy outcomes.
比较宫腔镜和腹腔镜绝育失败后的产科结局。
这项回顾性队列研究使用商业索赔行政数据库，调查了 2007 年至 2013 年期间的妊娠结局，包括活产、早产、死产、自然流产、治疗性流产、异位妊娠和妊娠滋养细胞疾病。我们使用 Z 检验比较了基于绝育类型的每 100 人年的妊娠结局。Cox 比例风险模型控制了患者年龄、地理位置、城市程度、合并症和保险类型。
我们评估了 817 名女性中的 997 例妊娠结局，这些女性来自于总共 70115 名有宫腔镜绝育（n=387 例妊娠/27724 例）或腹腔镜绝育（n=610 例妊娠/42391 例）史的女性。接受宫腔镜绝育的女性年龄略大于接受腹腔镜绝育的女性，但其他方面相似。最常见的结局是活产，宫腔镜绝育后活产的可能性大于腹腔镜绝育（调整后的危险比 1.32，95%置信区间 1.09-1.60）。两组自发性流产率无统计学差异。宫腔镜绝育后治疗性流产的发生率更高（调整后的危险比 1.49，95%置信区间 1.10-2.01），而异位妊娠的发生率更低（调整后的危险比 0.12，95%置信区间 0.05-0.29）。
与腹腔镜绝育相比，宫腔镜绝育与较高的活产率和较低的异位妊娠率相关。两组自发性流产和早产率相似。这些数据不支持宫腔镜绝育对后续妊娠结局有不良影响。
