Management of Pregnancy after Radical Trachelectomy: Case Reports and Systematic Review of the Literature

Abstract

This article reviews the existing literature on pregnancy outcomes following radical trachelectomy for low-stage cervical carcinoma and describes the guidelines in our institution for obstetrical management after managing two pregnancies following radical trachelectomy. We performed a literature search in PUBMED, MEDLINE, and EMBASE for the keywords "radical trachelectomy," "pregnancy," or "fertility" from 1994 to the present. All observational studies were included, and duplicate cases were excluded from our review. In addition to our cases, 14 studies were reviewed and included. Selection criteria included case reports or series detailing pregnancy outcomes including gestational age at delivery. Data regarding pregnancy outcomes were tabulated from the reports with focus on additional procedures such as vaginal occlusion and delivery outcomes. Where data were unclear, the authors personally contacted the authors of previously published manuscripts for further data. Our results revealed that 40% of women conceived following radical trachelectomy. Of them they had a preterm delivery rate of 25%, and 42% culminated in delivery of a live born infant at term. The use of the vaginal occlusion procedure did not appear to prolong gestation when compared with those women who did not have the procedure, but the majority of successful pregnancy outcomes have occurred with a cerclage in place. In conclusion, successful pregnancy outcome is possible after radical trachelectomy for cervical cancer, with two thirds of pregnancies resulting in a live birth, including those of both cases reported. There is a higher frequency of adverse perinatal outcomes in these patients, however, and careful interdisciplinary planning and counseling prior to undertaking the trachelectomy is recommended.

First case of vaginal radical trachelectomy in a pregnant Japanese woman

“…According to the review by Jolly et al [8], the preterm delivery rate after RT was 49 in 200 (24.5%), and 14 of the 49 (29%) preterm deliveries \37 weeks of gestation were preceded by pPROM, which is clearly higher than reported for the general population. The cause of such adverse pregnancy outcomes is believed to be vaginal and uterine cervical infection.…”

“…A recent review of the published literature totaling more than 600 cases confirmed an overall recurrence rate of\5% and death rate of \3% [8]. However, it is well known this treatment modality is associated with a variety of adverse pregnancy outcomes, including second trimester loss, pPROM, and the subsequent occurrence of preterm delivery [2,3].…”

Fertility outcome following transvaginal cervicoisthmic cerclage using a polypropylene sling

“…The median age of the patients was 34 years (interquartile range [IQR], 30-37 years). The median body mass index (BMI, calculated as weight in International Journal of Gynecology and Obstetrics 109 (2010) 37-40 kilograms divided by the square of height in meters) was 22 (IQR,(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). No patient presented with inherited thrombophilias.…”

Cervical conization and sentinel lymph node mapping in the treatment of stage I cervical cancer: Is less enough?

“…The reproductive outcomes of the radical trachelectomy are promising. Approximately two thirds of patients are able to conceive, and the rate of preterm deliveries is approximately 25% [3,4].…”