Department of Obstetrics & Gynecology and Reproductive Medecine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France.
Faculty of Medicine, Paris Saclay University, Le Kremlin-Bicêtre, France.
Hum Reprod. 2024 Jun 3;39(6):1231-1238. doi: 10.1093/humrep/deae089.
What are the pregnancy and obstetric outcomes in women with atypical hyperplasia (AH) or early-stage endometrial cancer (EC) managed conservatively for fertility preservation?
The study found a live birth rate of 62% in patients with AH or EC after conservative treatment, with higher level of labour induction, caesarean section, and post-partum haemorrhage.
Fertility-sparing treatment is a viable option for women with AH or EC during childbearing years, but the outcomes of such treatments, especially regarding pregnancy and obstetrics, need further exploration.
STUDY DESIGN, SIZE, DURATION: This retrospective cohort study analysed data from January 2010 to October 2022, involving 269 patients from the French national register of patients with fertility-sparing management of AH/EC.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Women above 18 years of age, previously diagnosed with AH/EC, and approved for fertility preservation were included. Patients were excluded if they were registered before 2010, if their treatment began <6 months before the study, or if no medical record on the pregnancy was available.
In total, 95 pregnancies in 67 women were observed. Pregnancy was achieved using ART in 63 cases (66%) and the live birth rate was 62%, with early and late pregnancy loss at 26% and 5%, respectively. In the 59 cases resulting in a live birth, a full-term delivery occurred in 90% of cases; 36% of cases required labour induction and 39% of cases required a caesarean section. The most common maternal complications included gestational diabetes (17%) and post-partum haemorrhaging (20%). The average (±SD) birthweight was 3110 ± 736 g; there were no significant foetal malformations in the sample. No significant difference was found in pregnancy or obstetric outcomes between ART-obtained and spontaneous pregnancies. However, the incidence of induction of labour, caesarean section, and post-partum haemorrhage appears higher than in the general population.
LIMITATIONS, REASONS FOR CAUTION: The retrospective nature of the study may introduce bias, and the sample size might be insufficient for assessing rare obstetric complications.
This study offers valuable insights for healthcare providers to guide patients who received fertility-sparing treatments for AH/EC. These pregnancies can be successful and with an acceptable live birth rate, but they seem to be managed with caution, leading to possible tendency for more caesarean sections and labour inductions. No increase in adverse obstetric outcomes was observed, with the exception of suspicion of a higher risk of post-partum haemorrhaging, to be confirmed.
STUDY FUNDING/COMPETING INTEREST(S): No funding was received for this study. There are no conflicts of interest to declare.
N/A.
对于因生育保存而接受保守治疗的患有非典型增生（AH）或早期子宫内膜癌（EC）的女性，其妊娠和产科结局如何？
研究发现，在接受保守治疗后，AH 或 EC 患者的活产率为 62%，但引产、剖宫产和产后出血的发生率更高。
对于生育年龄的 AH 或 EC 女性，保留生育力的治疗是一种可行的选择，但此类治疗的结果，尤其是妊娠和产科方面的结果，需要进一步探讨。
研究设计、大小和持续时间：这是一项回顾性队列研究，分析了 2010 年 1 月至 2022 年 10 月期间来自法国生育保存管理 AH/EC 患者注册中心的 269 名患者的数据。
参与者/材料、设置和方法：纳入年龄在 18 岁以上、先前诊断为 AH/EC 且获得生育保存批准的女性。如果患者在 2010 年前登记、治疗开始前<6 个月或无法获取妊娠医疗记录，则将其排除在外。
总共有 67 名女性的 95 次妊娠得到了观察。63 例（66%）使用辅助生殖技术（ART）实现了妊娠，活产率为 62%，早期和晚期妊娠丢失率分别为 26%和 5%。在 59 例活产中，90%的病例为足月分娩；36%的病例需要引产，39%的病例需要剖宫产。最常见的产妇并发症包括妊娠糖尿病（17%）和产后出血（20%）。样本的平均（±SD）出生体重为 3110±736g；无明显胎儿畸形。ART 获得的妊娠和自然妊娠的妊娠或产科结局无显著差异。然而，引产、剖宫产和产后出血的发生率似乎高于一般人群。
局限性、谨慎的原因：研究的回顾性性质可能会引入偏倚，并且样本量可能不足以评估罕见的产科并发症。
本研究为医疗保健提供者提供了有价值的见解，以指导接受 AH/EC 生育保存治疗的患者。这些妊娠可以成功进行，并且具有可接受的活产率，但似乎需要谨慎管理，可能导致更多的剖宫产和引产。除了产后出血风险较高的可疑情况（有待证实）外，未观察到其他不良产科结局增加。
研究资金/利益冲突：本研究未获得资金。没有利益冲突需要申报。
无。
