The association between operative hysteroscopy prior to assisted reproductive technology and cervical insufficiency in s
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GYNECOLOGIC ENDOCRINOLOGY AND REPRODUCTIVE MEDICINE
The association between operative hysteroscopy prior to assisted reproductive technology and cervical insufficiency in second trimester Ali Gökçe1 · Yavuz Emre Şükür1 · Batuhan Özmen1 · Murat Sönmezer1 · Bülent Berker1 · Ruşen Aytaç1 · Cem Somer Atabekoğlu1 Received: 22 April 2020 / Accepted: 28 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To assess the association between operative hysteroscopy prior to assisted reproductive technology (ART) cycle and cervical insufficiency (CI) in the second trimester of pregnancy. Methods 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). Results 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). Conclusions 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. Keywords Cervical incompetence · Cervical insufficiency · Operative hysteroscopy · Miscarriage · Preterm birth · Second trimester
Introduction Pregnancy loss during the second trimester (between 13 and 27 weeks of gestation) is a rare and severe condition. Among all pregnancies, 1–5% are lost between 13 and 19th gestational weeks, and 0.3% is lost between 20 and 27th gestational weeks [1]. According to the American College of Obstetricians and Gynecologists (ACOG), the term ‘cervical insufficiency’ (CI) is used to describe the inability of the uterine cervix to retain a pregnancy in the absence of * Ali Gökçe [email protected] 1
Department of Obstetrics and Gynaecology, Cebeci Hospital, Ankara University School of Medicine, Dikimevi, 06100 Ankara, Turkey
the signs and symptoms of clinical contractions, or labor, or both in the second trimester [2]. The plausible underlying pathophysiology is poorly understood [3]. Risk fa
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