Pregnancy after radical trachelectomy: a real option?

INTRODUCTION: Radical trachelectomy is a surgical procedure for early-stage cervical carcinoma with preservation of the childbearing capacity. The current article presents a review of studies describing the results and complications of pregnancies after this procedure.

METHODS: Sixteen studies were included (involving 355 radical trachelectomy procedures). Studies were reviewed for the number of patients included, the number attempting to conceive, the number who achieved pregnancy, the number of pregnancies achieved, the numbers of first and second trimester losses, and when delivery occurred in the third trimester.

RESULTS: One hundred and fifty-three patients attempted to conceive during the follow-up period (range 1-144 months), this accounts for 43% of the patients that underwent radical trachelectomy. 70% of the patients attempting to conceive succeeded once or more than once. 161 pregnancies were described, finally resulting in 49% term deliveries. In about 15% of the patients who tried to conceive, cervical stenosis was found and resulted in menstrual disorders or fertility problems. Surgical dilatation resolved this problem in most cases but had to be repeated. Complications during pregnancy involved second trimester loss (13/161) and premature (< or =36 weeks AD) delivery (33/161).

CONCLUSIONS: Pregnancy after radical trachelectomy is feasible. For various reasons, a number of patients (57%) did not try to get pregnant after the surgical procedure. The majority of the patients who tried to conceive after radical trachelectomy succeeded once or more than once (70%). Patients attempting to conceive need to be informed of the complications and risk factors, in particular, second trimester loss and premature delivery caused by premature rupture of membranes. Once pregnant, patients need to be carefully followed for cervical incompetence and other risk factors for premature rupture of membranes.