Changes of uterine blood flow after vaginal radical trachelectomy (VRT) in patients with early-stage uterine invasive cervical cancer

Abstract

Background. Vaginal radical trachectomy (RT) ligates and cuts several arteries supplying the uterus. Changes of blood supply to the uterus in two patients who experienced pregnancy and delivery were studied by using 3-D CT scanning. Effects of changes of blood supply to the uterus on the pregnancy courses were also examined.Methods. Vascular distribution in the uterus was studied in two patients who received vaginal RT after delivery. Effects of changes of vascular distribution after vaginal RT were studied with respect to pregnancy courses and cervical functions.Results. New arterial vascularization from the ascending branches of uterine arteries or other arteries occurred, and these new vessels seemed to supply blood to the remaining cervix. Differences of fetal growth and histopathological changes in the placenta between the two patients could not be detected.Conclusion. Ligation and cutting of several supplying arteries by RT induces new areterial vascularization and it does not seem to affect fetal growth and placental function.

Obstetric Outcomes and Complications After Vaginal Radical Trachelectomy: A Case Report

“…There is no strong evidence in current literature that fetal growth and placental function is affected with respect to the neovasculization [18] and healing process after an RT. In general, in an RT, cervix and upper vagina with a surrounding tissue of 1 -2 cm cuff of paracervical tissues are removed.…”

“…PPROM is a recognized complication and should be treated with 10-day course of erythromycin alone as a prophylactic antibiotic [18]. This has shown a statistically significant reduction in chorioamnionitis as well as a decrease in the number of babies born within 48 h and 7 days of PPROM onset [19].…”

Early Invasive Cervical Cancer During Pregnancy

“…19,20 This section of the uterine arteries induces an inadequate vascularization of the uterus and, consequently, an increased risk of miscarriage. 27 Manipulation of the uterus is increased when performing ART in comparison with VRT. This manipulation may induce an increased risk of miscarriage.…”

“…In fact, after ART, uterine vascularization derives only from the ovarian vessels, whereas after VRT, the ascending branch of the uterine artery is also preserved. 8,27 During VRT, even if uterine manipulation is limited, strong tractions on the uterus are performed and may create uterine vascularization problems. These tractions can induce an arterial compression, an ischemic process, and then an alteration of the placenta-fetal circulation.…”

Neonatal outcome in infants of patients with radical vaginal trachelectomy

“…In RVT, approximately half of the paracervical tissue is resected, including lymphatic and blood vessels and autonomic nerves together with about two thirds of the cervix. Doppler sonographic analysis showed that uterine artery fl ow is not altered [22,42] . However, the biological impact of altered uterine blood fl ow and changes of the anatomy have not been evaluated.…”