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

Summary

In a prospective cohort of 326 post‑vNOTES pregnancies matched to 326 controls, delivery mode, gestational age, neonatal weight, and maternal complications were comparable. Twin pregnancy, not the surgery-to-conception interval, independently increased risks of preterm birth and neonatal asphyxia. Early conception after vNOTES appeared safe.

Key Findings

• Obstetrical outcomes (delivery mode, gestational age, neonatal birth weight, maternal complications) were comparable between vNOTES and controls.
• The interval between vNOTES and conception was not associated with adverse outcomes.
• Twin pregnancy independently increased risks of preterm birth (HR 11.736) and neonatal asphyxia (HR 29.302); lower gestational age associated with asphyxia.

Clinical Implications

Patients desiring pregnancy after vNOTES do not appear to require prolonged delay; obstetrical outcomes were similar to controls. Counseling should emphasize that twin pregnancy, rather than surgical timing, drives preterm/asphyxia risk.

Limitations

• Non-randomized design with baseline differences (parity, prior cesarean) between groups
• Indication distribution varied across surgery‑to‑conception interval strata; single‑country context may limit generalizability

Future Directions

Multicenter prospective registries and randomized comparative effectiveness studies could refine risk estimates and assess long-term pelvic floor, sexual function, and cosmetic outcomes post‑vNOTES.