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Published on: January 17, 2019
Risk Factors for Reoperation and Subsequent Uterine Preservation in Congenital Cervical Malformation
Shuwen Zhang1, Na Chen1, Si Su2
1Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Common Mechanism, Research for Major Diseases, State Key Laboratory of Complex, Severe, and Rare Diseases, Peking Union Medical College Hospital, Academy of Medical Sciences and Peking Union Medical College (Drs. Zhang, Chen, Kang, Song, and Zhu), Beijing, China.
Objective:
To primarily evaluate the occurrence, causes, and risk factors of reoperation in patients with congenital cervical malformation, and secondarily to investigate the determinants of subsequent uterine preservation in this population.
Design:
Retrospective case-control study.
Setting:
A tertiary referring hospital in China.
Participants:
A total of 82 patients with congenital cervical malformation between January 2003 and April 2024.
Interventions:
Retrospective chart review and follow-up of patients diagnosed with congenital cervical malformation, including collection of data on demographics, disease characteristics, surgical details, reoperation timing and causes, and uterine preservation outcomes.
Results:
Among 82 patients, 47 (57.3%) underwent only one surgery without requiring reoperation, while 35 (42.7%) underwent reoperation. The median age at initial surgery was 13 (interquartile range, 12-16) years. The interval between primary and secondary surgeries ranged from 2 weeks to 12 years (mean 32.6 months). The main causes for reoperation included infection with fever, pelvic mass formation, restenosis or obstruction, and persistent abdominal pain. An accurate initial diagnosis and the placement of a cervical stent during the initial procedure were associated with prolonged reoperation-free survival (p < .05). Among the 35 patients who underwent reoperation, 19 (54.29%) successfully preserved the uterus, while 16 (45.71%) ultimately required hysterectomy. Cervical obstruction type was independently associated with successful uterine preservation (p = .005).
Conclusion:
An accurate initial diagnosis and intraoperative placement of a cervical stent were associated with longer reoperation-free intervals. Notably, patients with cervical obstruction demonstrated higher success rates with uterine-sparing procedures compared to those with other types of congenital cervical malformation.
