Department of Obstetrics and Gynaecology, Cebeci Hospital, Ankara University School of Medicine, Dikimevi, 06100, Ankara, Turkey.
Arch Gynecol Obstet. 2021 May;303(5):1347-1352. doi: 10.1007/s00404-020-05863-1. Epub 2020 Nov 20.
To assess the association between operative hysteroscopy prior to assisted reproductive technology (ART) cycle and cervical insufficiency (CI) in the second trimester of pregnancy.
A retrospective cohort study was conducted. The charts of all women who got pregnant following an ART cycle between January 2015 and June 2018 were reviewed. The study group consisted of pregnant women who underwent operative hysteroscopy within 6 months before conception. The control group consisted of pregnant women who did not undergo hysteroscopy or any type of cervical surgical procedure before conception. The primary outcome measure was CI during the second trimester (13-27 weeks of gestation).
A total of 363 pregnancies achieved by ART cycles were assessed. After the exclusion of multiple pregnancies (n = 19), previous surgical procedures (n = 4) and first-trimester pregnancy losses (n = 80), there were 29 women in the study group and 231 women in the control group. The mean ages of the study and control groups were 31.2 ± 4.06 and 29.82 ± 4.71 years, respectively (P = 0.13). The indications for operative hysteroscopy were uterine septum (n = 19), T-shaped uterus (n = 4), endometrial polyp (n = 4), and submucosal fibroids (n = 2). The rates of CI in the study and control groups were 13.7% (4/29) and 3.4% (8/231), respectively (P = 0.012). The term delivery rates in the study and control groups were 79.3 and 91.8%, respectively (P = 0.044).
Operative hysteroscopy prior to ART cycles is significantly associated with CI between 13 and 27 weeks of gestation. Further investigation with larger cohorts is urgently needed to clarify this issue.
评估辅助生殖技术（ART）周期前的手术性宫腔镜检查与妊娠中期（13-27 孕周）宫颈机能不全（CI）之间的关联。
进行了一项回顾性队列研究。对 2015 年 1 月至 2018 年 6 月期间进行 ART 周期妊娠的所有女性的病历进行了回顾。研究组由妊娠前 6 个月内行手术性宫腔镜检查的孕妇组成。对照组由妊娠前未行宫腔镜检查或任何类型宫颈手术的孕妇组成。主要结局指标为妊娠中期（妊娠 13-27 周）CI。
共评估了 363 例通过 ART 周期实现的妊娠。排除多胎妊娠（n=19）、既往手术史（n=4）和早孕期流产（n=80）后，研究组有 29 例孕妇，对照组有 231 例孕妇。研究组和对照组的平均年龄分别为 31.2±4.06 岁和 29.82±4.71 岁（P=0.13）。手术性宫腔镜检查的适应证为子宫纵隔（n=19）、T 型子宫（n=4）、子宫内膜息肉（n=4）和黏膜下肌瘤（n=2）。研究组和对照组 CI 的发生率分别为 13.7%（4/29）和 3.4%（8/231）（P=0.012）。研究组和对照组的足月分娩率分别为 79.3%和 91.8%（P=0.044）。
ART 周期前的手术性宫腔镜检查与 13-27 孕周之间的 CI 显著相关。需要进一步进行更大规模队列的研究来澄清这一问题。
