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Obstetric Outcomes After Failed Hysteroscopic and Laparoscopic Sterilization Procedures

Brandi, Kristyn MD, MPH; Morgan, Jake R. PhD; Paasche-Orlow, Michael K. MD; Perkins, Rebecca B. MD, MS; White, Katharine O'Connell MD, MPH

doi: 10.1097/AOG.0000000000002446
Contents: Original Research

OBJECTIVE: To compare obstetric outcomes after failed hysteroscopic and laparoscopic sterilization.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Hysteroscopic sterilization is associated with higher rates of live birth and lower rates of ectopic pregnancy and is not associated with adverse pregnancy outcomes compared with laparoscopic sterilization.

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.

Corresponding author: Kristyn Brandi, MD, MPH, 232 East 2nd Street, Apt 709, Los Angeles, CA 90012; email: kristyn.brandi@gmail.com.

Funding for statistical assistance was received from the Boston Medical Center Department of Obstetrics and Gynecology.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.