Vaginal Radical Trachelectomy: A Valuable Fertility-Preserving Option in the Management of Early-Stage Cervical Cancer, a Series of 50 Pregnancies and Review of the Literature

Abstract

The authors conducted a retrospective review of their patients with cervical cancer who been treated with vaginal radical trachelectomy (VRT) to preserve fertility. Of a total 82 patients, 31 were identified who became pregnant after this procedure and are the subjects of this report. Obstetric data was gathered through chart review and telephone calls to patients and/or their referring physicians. Because most patients received their obstetric care from a local obstetrician or high-risk specialist, the management of pregnancies was not uniform, although all patients were delivered by cesarean section. Patients were a median 32 years of age (range, 21-42 years). Three fourths (n = 53, 74%) were nulliparous, 19% (n = 14) had one child, and 7% (n = 5) had 2 or more children. After VRT, 31 women (43%) had a successful pregnancy. Among the remaining 38 patients, 33 did not attempt conception, 2 died of disease, 2 underwent hysterectomy, and one received adjuvant radiation therapy. In all, 7 women experienced infertility problems. Four became pregnant and 3 were unable to conceive. Thirty-one women had a total of 50 pregnancies. Six patients had 2 pregnancies, 2 had 3 pregnancies, and 3 had 4 pregnancies. In the 50 pregnancies, there were 10 miscarriages (8 in the first trimester and 2 in the second trimester), 2 pregnancy terminations, and 2 who were pregnant at the time of this report. Eight of the remaining 36 pregnancies ended prematurely, 3 before 32 weeks of gestation and 5 between the 34th and 36th weeks. Twenty-eight pregnancies reached 37 weeks or more (78%). All deliveries over 37 weeks were by elective cesarean section. Sixteen percent of the pregnancies resulted in a delivery before 37 weeks. Two patients accounted for the 5 earliest deliveries, including 2 in the second trimester at 20 and 25 weeks and 3 in the third trimester at 28, 31, and 34 weeks. The 2 babies delivered at 25 and 28 weeks survived and had no evidence of long-term problems at 7 and 10 years. The 31-week baby was born after premature membrane rupture and died of sepsis within 36 hours. The remaining 34 women had successful pregnancies, which reached at least 34 weeks gestation. The only other infant death was a full-term baby born with trisomy-18 and severe cardiac malformations. There were 2 women with spontaneous erosion of the cerclage suture. Both occurred in the first 15 patients when the cerclage was placed more deeply within the cervical stroma.