Expectant management for early pregnancy miscarriage after radical trachelectomy: A single hospital‐based study

Abstract

Introduction Women who have undergone radical trachelectomy as a fertility‐sparing treatment for early‐stage cervical cancer may be at higher risk for retained tissues after early‐term miscarriage due to cervical cerclage or cervical necrosis. Dilatation and curettage or aspiration may present additional risks in these women. The aim of this study was to assess the efficacy of expectant management for early pregnancy miscarriage after radical trachelectomy. Material and methods Keio University Hospital records were reviewed for women who conceived after abdominal radical trachelectomy and received perinatal care between 1 April 2012 and 31 March 2020. A total of 62 women (76 pregnancies) were identified, and 13 of these women experienced miscarriage before 12 gestational weeks. The management and outcome of these cases were reviewed in detail. Results The median maternal age at miscarriage was 39 years (range 31–42 years) and the median duration from abdominal radical trachelectomy to conception was 2.60 years (range 0.49–7.30 years). Cervical necrosis before conception occurred in one case (8%). One patient requested treatment with aspiration and the remaining 12 cases were managed with observation for a median of 23 days (range 7–50 days). There were no cases of endometritis or cases requiring dilatation and curettage for residue tissue. Further, no cases developed laceration of the residual cervix and no loss of cerclage sutures after discharge was noted. Conclusions Expectant management seems to be safe and appropriate for first trimester miscarriage after abdominal radical trachelectomy.

Spontaneous miscarriage/abortion in the first trimester and expectant management – a meta-analysis approach

“…2683 studies were excluded because there were duplicate studies in the databases. After a complete evaluation, 11 articles [ 1 – 3 , 17 , 18 , 25 – 30 ] were included in this systematic review, as shown in Figure 1 , comprising 2889 patients undergoing first-trimester miscarriage with 1709 undergoing expectant care for miscarriage in the first trimester. Seven studies [ 1 – 3 , 17 , 18 , 25 , 29 ] were considered for the meta-analysis.…”

Pregnancy outcomes following radical trachelectomy for early‐stage cervical cancer: A retrospective observational study in the Kanto area, Japan

“…Previous reports have described that expectant management could be useful and appropriate. [19][20][21] Since there is a fear of cervical laceration or intrauterine infection due to aspiration or D&C, expectant management was recommended in our TA B L E 1 Oncologic characteristics in women after radical trachelectomy.…”