Obstetrical outcomes after transvaginal natural orifice transluminal endoscopic surgery for benign gynecological conditions: a prospective cohort study.

BACKGROUND

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is increasingly used for benign gynecologic conditions; however, evidence regarding subsequent obstetrical outcomes and the optimal interval between surgery and conception remains limited. This study aimed to evaluate pregnancy outcomes after fertility-preserving vNOTES and to assess whether the postoperative interval influences the risk of adverse outcomes.

METHODS

This prospective cohort study included 326 women who conceived after fertility-preserving vNOTES performed for benign gynecological diseases with cosmetic considerations between April 2022 and June 2024, along with 326 matched controls without a history of vNOTES during the same period. Post-vNOTES pregnancies were stratified by the interval from surgery to conception (≤ 3, 3-6, and > 6 months). Obstetrical outcomes, including delivery mode, gestational age, neonatal birth weight, maternal complications, preterm birth, and neonatal asphyxia, were compared. Multivariable logistic regression was performed to identify independent risk factors for preterm birth and neonatal asphyxia.

RESULTS

Baseline characteristics were generally comparable, although the control group had higher parity and more prior cesarean deliveries (both p < 0.001). The distribution of surgical indications differed across interval groups (p < 0.001). The vNOTES group had higher rates of assisted reproductive technology and twin pregnancies (both p < 0.001). No significant differences were observed between groups in delivery mode, gestational age at birth, neonatal birth weight, or maternal complications. In regression analyses, twin pregnancy was independently associated with preterm birth (HR 11.736, p < 0.001) and neonatal asphyxia (HR 29.302, p = 0.019), while lower gestational age was also associated with neonatal asphyxia (HR 0.863, p = 0.018). The interval between vNOTES and conception was not associated with adverse outcomes.

CONCLUSIONS

Pregnancy outcomes following vNOTES are comparable to those without prior vNOTES. Early conception after vNOTES does not appear to increase the risk of adverse obstetrical outcomes, supporting vNOTES as a safe fertility-preserving surgical approach without the need for prolonged delay before conception.

TRIAL REGISTRATION: ChiCTR2200059282, registered on April 28, 2022 ( https://www.chictr.org.cn/showproj.html?proj=167900 ).