Key content Cervical cancer continues to affect many women in the UK with over half under the age of 45 years at the time of diagnosis; with a trend towards starting families later in life this raises fertility concerns. While the standard treatment for stage IA2 or IB1 cervical cancer is a radical hysterectomy, radical trachelectomy has been shown to have equivalent 5‐year survival and is a surgical option if there is a wish to preserve fertility. Although trachelectomies are performed by gynaecological oncologists, the management of any subsequent pregnancies falls under the remit of obstetricians who therefore require a sound knowledge of the procedure and potential obstetric sequelae. Pregnancies following trachelectomy are high risk because of the increased rate of mid‐trimester miscarriage and preterm delivery, often as a consequence of preterm prelabour rupture of membranes. Delivery is by caesarean section, traditionally by classical section as a permanent isthmic suture is placed at the time of trachelectomy, but nowadays a transverse incision may be used to reduce morbidity and the implications on future fertility. Learning objectives Management of a pregnancy following radical trachelectomy. Intrapartum care of post‐radical trachelectomy pregnancy and complication risks. Impact of trachelectomy and subsequent pregnancy on the woman. Ethical issues Informed consent surrounding trachelectomy and future pregnancies.

Objective: to describe the impact of COVID-19 on the management of women with ectopic pregnancy. Design: a multicentre observational study comparing outcomes from a prospective cohort during the pandemic [Covid-ectopic pregnancy registry (CEPR)] compared to an historical pre-pandemic cohort [non-Covid ectopic pregnancy registry (NCEPR)]. Setting: five London university hospitals. Population and Methods: consecutive patients diagnosed clinically and/or radiologically with ectopic pregnancy (March/2020-Aug/2020) were entered into the CEPR and results were compared to the NCEPR cohort (January/2019-June/2019). An adjusted analysis was performed for potentially confounding variables. Main outcome measures: patient demographics, management (expectant, medical and surgical), length of treatment, number of hospital visits (non-surgical management), length of stay (surgical management) and 30-day complications. Results: 341 patients met inclusion: 162 CEPR and 179 NCEPR. A significantly lower percentage of women underwent surgical management versus non-surgical management in the CEPR versus NCEPR (58.6% [95/162] vs 72.6% [130/179]; p= 0.007]. Amongst patients managed with expectant management the CEPR had a significantly lower mean number of hospital visits compared to NCEPR [3.0 [IQR 2.0] vs 9.0 [IQR 9.0], p= <0.001]. Amongst patients managed with medical management, the CEPR had a significantly lower median number of hospital visits vs NCEPR (6.0 [IQR 3.0] vs 9 [IQR 4.0], p= 0.003]. There was no observeddifference in complication rates between cohorts. Conclusion: women were found to undergo significantly higher rates of non-surgical management during COVID-19 first wave compared with a pre-pandemic cohort. Women managed non-surgically in CPER cohort were also managed with fewer hospital attendances. This did not lead to an increase in observed complications rates.

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