Pelvic organ prolapse recurrence after pregnancy following uterine-sparing prolapse repair: a systematic review and meta-analysis

Sarah B Andebrhan; Ashley T Caron; Alec Szlachta-McGinn; Pooja S Parameshwar; Nicholas J Jackson; Amy E Rosenman; Jennifer T Anger; A Lenore Ackerman

doi:10.1007/s00192-022-05306-2

Pelvic organ prolapse recurrence after pregnancy following uterine-sparing prolapse repair: a systematic review and meta-analysis

Int Urogynecol J. 2023 Feb;34(2):345-356. doi: 10.1007/s00192-022-05306-2. Epub 2022 Aug 3.

Authors

Sarah B Andebrhan¹, Ashley T Caron², Alec Szlachta-McGinn³, Pooja S Parameshwar⁴, Nicholas J Jackson⁵, Amy E Rosenman³, Jennifer T Anger⁶, A Lenore Ackerman^{7

8}

Affiliations

¹ Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, IL, USA.
² Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
³ Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
⁴ Stanford School of Medicine, Palo Alto, CA, USA.
⁵ Department of Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USA.
⁶ Department of Urology, University of California, San Diego, CA, USA.
⁷ Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. AAckerman@mednet.ucla.edu.
⁸ Department of Urology, Division of Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at UCLA, Box 951738, Los Angeles, CA, 90095-1738, USA. AAckerman@mednet.ucla.edu.

PMID: 35920935
DOI: 10.1007/s00192-022-05306-2

Abstract

Introduction: We sought to determine rates of pelvic organ prolapse (POP) recurrence following pregnancy and delivery in reproductive-age women with prior hysteropexy.

Methods: Scopus, MEDLine, EMBASE, Cochrane Library, and ClinicalTrials.gov databases were searched from inception to May 2020 for combinations of any of the keywords: "pregnancy", "delivery", "fertility", or "cesarean" with a comprehensive list of uterine-sparing surgical procedures for POP repair. Using approach, 1,817 articles were identified describing surgical, uterine-sparing POP repair techniques and subsequent pregnancy and delivery outcomes in reproductive-age women. RESULTS: Twenty-seven studies describing 218 pregnancies, including 215 deliveries and 3 abortions, were summarized using narrative review and descriptive statistics. Successful pregnancies were reported following a diverse range of uterine-sparing prolapse repairs, both native tissue and mesh-augmented, that utilized vaginal, open abdominal, and laparoscopic approaches. We observed shifts from native tissue repairs to mesh-augmented laparoscopic repairs over time. POP recurrence occurred in 12% of subjects overall, 15% after vaginal and 10% after abdominal prolapse repairs. While meta-analysis identified higher recurrence rates after vaginal delivery (15%) than cesarean section (10%), due to small study numbers, multiple confounders, and heterogeneity between studies, no significant differences in recurrence rates could be identified between vaginal and abdominal surgical approaches, utilization of mesh augmentation, or mode of delivery.

Conclusion: Although literature on pregnancy following uterine-sparing POP repair is limited, available data suggest that prolapse recurrence after pregnancy and delivery remains similar to that after prolapse repair without subsequent pregnancies with few documented perinatal complications.

Systematic review registration: PROSPERO, CRD42021247722.

Keywords: Cesarean section; Hysteropexy; Pelvic prgan prolapse; Surgical mesh; Uterine prolapse; Vaginal delivery.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Cesarean Section
Female
Gynecologic Surgical Procedures / methods
Humans
Pelvic Organ Prolapse* / surgery
Pregnancy
Surgical Mesh
Treatment Outcome
Uterine Prolapse* / surgery
Uterus