Clinical characteristics and influencing factors of adverse outcomes following clinical pregnancy after laparoscopic tubal anastomosis.

OBJECTIVE

To identify clinical characteristics and risk factors for adverse pregnancy outcomes after clinical pregnancy following laparoscopic tubal anastomosis (LTA).

METHODS

Retrospective analysis of 253 patients undergoing LTA (May 2016-December 2022) achieving clinical pregnancy. Patients were categorized into pregnancy loss (n = 70) and live birth groups (n = 183). Univariate/multivariate logistic regression identified risk factors. Restricted cubic splines (RCS) explored dose-response relationships. Receiver operating characteristic (ROC) and decision curve analysis (DCA) assessed prediction.

RESULTS

The majority of patients achieved successful delivery, with a live birth rate of 72.3%. However, the overall pregnancy loss rate was 27.7%, including an ectopic pregnancy incidence of 10.7% (27/253) and a miscarriage rate of 17.0% (43/253). Advanced maternal age and elevated body mass index (BMI) were identified as independent risk factors for pregnancy loss after LTA (age: OR = 1.123, 95% CI: 1.010-1.253; BMI: OR = 1.136, 95% CI: 1.030-1.256). ROC analysis demonstrated that both age and BMI exhibited moderate discriminative ability for pregnancy loss (AUC: age = 0.723, BMI = 0.724). RCS analysis indicated a linear relationship between age and pregnancy loss (p = 0.464) but a nonlinear association for BMI (p < 0.001). DCA confirmed the clinical utility of age and BMI in predicting pregnancy loss within a specific high-risk threshold range.

CONCLUSION

Advanced maternal age and higher BMI significantly increase the risk of pregnancy loss after LTA. These findings highlight the need for individualized preoperative counseling and postoperative monitoring to optimize reproductive outcomes in this patient population.