Brandi K, et al. - This retrospective cohort study was performed to compare obstetric outcomes after failed hysteroscopic and laparoscopic sterilization. Compared with laparoscopic sterilization, hysteroscopic sterilization was correlated with higher rates of live birth and lower rates of ectopic pregnancy. In both groups, spontaneous abortion and preterm birth rates were similar. Findings did not support an adverse effect of hysteroscopic sterilization on subsequent pregnancy outcomes.

Methods

• The physicians investigated 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.
• A Z-test was used to compare pregnancy outcomes per 100 person-years based on type of sterilization.
• In this study, Cox proportional hazard models controlled for patient age, geographic region, urbanicity, comorbidities, and insurance type.

Results

• Out 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), 997 pregnancy outcomes were evaluated in 817 women.
• Compared to women undergoing laparoscopic sterilization, women undergoing hysteroscopic sterilization were slightly older, but otherwise similar.
• Live birth was the most common outcome, which was more likely after hysteroscopic sterilization compared with laparoscopic sterilization (adjusted hazard ratio 1.32, 95% CI 1.09-1.60).
• Between the 2 groups, the rate of spontaneous abortion was not statistically significantly different.
•  The occurrence of therapeutic abortion was more frequently noted after hysteroscopic sterilization (adjusted hazard ratio 1.49, 95% CI 1.10-2.01) when compared with laparoscopic sterilization.
• On the other hand, ectopic pregnancies occurred less often after hysteroscopic sterilization (adjusted hazard ratio 0.12, 95% CI 0.05-0.29) than with laparoscopic sterilization.