Pregnancy After Uterine-Preserving Prolapse Surgery: Obstetric Outcomes and Prolapse Recurrence Following Native Tissue and Mesh-Augmented Repairs

INTRODUCTION AND HYPOTHESIS: To evaluate current literature on uterine-sparing surgery for pelvic organ prolapse (POP) with respect to subsequent obstetric outcomes and POP recurrence. METHODS: A comprehensive search was conducted through MEDLINE and PubMed from 1993 to November 2025 using PRISMA guidelines for studies exploring patients who had subsequent deliveries after undergoing surgical management of POP. Articles were evaluated by three independent reviewers for quality, relevance, and outcomes assessment. RESULTS: Eighteen studies (six prospective, nine retrospective, and three case series) that included follow-up data on 126 patients with pregnancy after POP surgery were included in data analysis. The mean follow-up period was 37.2 months. The majority of patients had previously undergone native tissue POP repair, 64.3%, vs 35.7% who had undergone mesh-augmented repairs. Nearly all (94.8%) deliveries after POP surgery occurred at term. Cesarean delivery (CD) was common (65.8%). No neonatal complications were reported. POP recurrence rate was 11.7% with the majority (71.4%) occurring after native tissue repair. Analyzed separately, among 14 case reports of pregnancies following mesh-based sacrohysteropexy, cesarean delivery was common (85.7%) and prolapse recurrence rate was low. CONCLUSION: Current evidence suggests that uterine-sparing prolapse surgery, whether mesh-augmented or native tissue, is associated with favorable obstetric outcomes, low neonatal risk, and low rates of POP recurrence; however, longitudinal data is limited in the absence of randomized controlled trials.