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Management of pregnancy after radical trachelectomy. Gynecol Oncol 2021; 162:220-225. [PMID: 33902946 DOI: 10.1016/j.ygyno.2021.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/20/2021] [Indexed: 11/23/2022]
Abstract
Radical trachelectomy (RT) is a surgery for early-stage cervical cancer treatment that preserves the childbearing ability, and its use has become increasingly common worldwide. Thus, the rate of conception in women who have undergone RT is increasing. However, pregnancy after RT is associated with a higher risk of several obstetric complications such as preterm delivery, preterm premature membrane rupture, and abnormal bleeding from varices at the site of uterovaginal anastomosis. Furthermore, since RT have a residual prophylactic cerclage, it is difficult to manage first- and second-trimester miscarriages. There is little previous data on the management of pregnancy after RT. In this review article, we summarize various management methods and experiences to provide a guide to clinicians for perinatal management after RT.
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Shinkai S, Ishioka S, Mariya T, Fujibe Y, Kim M, Someya M, Saito T. Pregnancies after vaginal radical trachelectomy (RT) in patients with early invasive uterine cervical cancer: results from a single institute. BMC Pregnancy Childbirth 2020; 20:248. [PMID: 32334568 PMCID: PMC7183613 DOI: 10.1186/s12884-020-02949-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/14/2020] [Indexed: 01/27/2023] Open
Abstract
Background Radical tracheletomy (RT) with pelvic lymphadenectomy has become an option for young patients with early invasive uterine cervical cancer who desire to maintain their fertility. However, this operative method entails a high risk for the following pregnancy due to its radicality. Methods We have performed vaginal RT for 71 patients and have experienced 28 pregnancies in 21 patients. They were followed up carefully according to the follow-up methods we reported previously. Their pregnancy courses and prognoses after the pregnancy were retrospectively reviewed. Results All the vaginal RTs were performed safely without serious complications, including 6 patients who underwent the operation during pregnancy. The median time to be pregnant after RT was 29.5 months. 13 patients (46%) became pregnant without artificial insemination by husband or assisted reproductive technology. Cesarean section was performed for all of them. The median time of pregnancy was 34 weeks, and emergent cesarean section was performed for 7 pregnancies (25%). The median birth weight was 2156 g. Four patients had trouble with cervical cerclage, and they suffered from sudden premature preterm rupture of the membrane (pPROM) during the second trimester of pregnancy. We underwent transabdominal cerclage (TAC) for all of them and careful management for the prevention of uterine infection was performed. One patient had a recurrence of cancer during pregnancy. Conclusions Both the obstetrical prognosis and oncological prognosis after vaginal RT have become favorable for pregnant patients after vaginal RT.
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Affiliation(s)
- Shota Shinkai
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Shinichi Ishioka
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan.
| | - Tasuku Mariya
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Yuya Fujibe
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Miseon Kim
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Masayuki Someya
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology, Sapporo Medical University, S1, W16, Chuou-ku, Sapporo, Hokkaido, 0608543, Japan
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