Pregnancy After Laparoscopic Hysteropexy: A Systematic Review

Area of Science:

• Urogynecology
• Minimally Invasive Surgery
• Reproductive Health

Background:

• Increasing demand for fertility-sparing treatments for pelvic organ prolapse (POP).
• Laparoscopic hysteropexy offers a uterus-preserving surgical option for POP.
• Need to understand pregnancy outcomes after hysteropexy for patient counseling.

Purpose of the Study:

• To systematically review the impact of pregnancy and delivery on POP recurrence after laparoscopic hysteropexy.
• To evaluate the safety and efficacy of uterus-sparing surgery for POP in women desiring future fertility.
• To inform patient counseling regarding fertility preservation and POP treatment.

Main Methods:

• Systematic literature review of MEDLINE, Web of Science, and Scopus databases until January 2025.
• Inclusion of case reports and case series on laparoscopic sacral hysteropexy (LSHP) for POP.
• Analysis of pregnancy and delivery outcomes in women who underwent LSHP.

Main Results:

• Review included 26 patients from 10 case reports and 3 case series, all treated with LSHP.
• All patients delivered via cesarean section at a mean gestational age of 38 weeks.
• Low recurrence rates observed: 4% recurrent uterine prolapse, 8% de novo anterior prolapse, 8% recurrent anterior prolapse, 4% posterior prolapse over 9 months follow-up.

Conclusions:

• Laparoscopic sacral hysteropexy (LSHP) appears safe for women of reproductive age with POP and incomplete family planning.
• Pregnancy following LSHP does not seem to negatively impact fetal growth or long-term apical support.
• Further research is crucial to establish definitive safety and efficacy data for subsequent pregnancies after uterus-sparing POP surgery.