Difficulty in the management of pregnancy after vaginal radical trachelectomy.
BACKGROUND
We have performed 26 vaginal radical trachelectomies (RTs) for patients with early invasive uterine cervical cancer since 2003 and, to date, have experienced 8 deliveries. The procedure has a high risk for preterm labor and the subsequent occurrence of preterm premature rupture of membranes (pPROM). We report the present situation and the limits of follow-up of pregnancy after vaginal RT.


METHODS
Our operative procedure is based on that of Dargent et al. We usually amputate the cervix approximately 10 mm below the isthmus. To remove the parametrium, we cut at the level of type II hysterectomy. Pregnancy courses after vaginal RT were studied in 8 patients with respect to symptoms, cervical length, and several infectious signs.


RESULTS
We recommended that patients enter hospital early in their second trimester, and prophylactic daily vaginal disinfection with povidone-iodine and an ulinastatin vaginal suppository were administered. Careful checking for vaginal infectious signs, as well as cervical length and abdominal tension of patients was also performed. Four patients followed up with this modality were able to continue their pregnancies until late in the third trimester. However, this follow-up modality was not effective for patients who showed cervical incompetence due to slack cervical cerclage. They suffered from pPROM at 26 and 19 weeks of gestation.


CONCLUSIONS
We need a new approach for the management of pregnant patients after vaginal RT with cervical incompetence due to slack cervical cerclage to prevent cervical infection.
Department of Obstetrics and Gynecology, Sapporo Medical University, School of Medicine, Minami 1-jo, Nishi 16-chome, Chuou-ku, Sapporo, Hokkaido, 060-8543, Japan.
Sakura
S
Takada
Shin-Ichi
S
Ishioka
Toshiaki
T
Endo
Tsuyoshi
T
Baba
Miyuki
M
Morishita
Yushi
Y
Akashi
Masahito
M
Mizuuchi
Hidefumi
H
Adachi
Miseon
M
Kim
Tsuyoshi
T
Saito
D000328:Adult; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000473:pathology; D006801:Humans; D007044:Hysterectomy; D007231:Infant, Newborn; D008197:Lymph Node Excision; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D014621:Vagina / Q000473:pathology / Q000601:surgery*