title: Pregnancy Outcomes After Abdominal Radical Trachelectomy for Early-Stage Cervical Cancer: A 13-Year Experience in a Single Tertiary-Care Center.
abstract: OBJECTIVE
  To investigate pregnancy outcomes in women after abdominal radical trachelectomy (RT) for early-stage cervical cancer.
  
  
  METHODS
  The patients' background, fertility, and pregnancy outcomes were reviewed in a total of 61 pregnancies in 48 of 172 women who underwent abdominal RT at Keio University Hospital between September 2002 and December 2013.
  
  
  RESULTS
  There were 5 women with stage IA1, 2 with stage IA2, and 41 with stage IB1. Histological types were as follows: squamous cell carcinoma (n = 36), adenocarcinoma (n = 10), and adenosquamous cell carcinoma (n = 2). The pregnancy rate of women attempting to conceive after abdominal RT was 44% (48/109). The mean ± SD duration from abdominal RT to conception was 3.1 ± 1.9 years. Of 61 pregnancies, 42 pregnancies were achieved by fertility treatment (in vitro fertilization-embryo transfer, 39; intrauterine insemination, 3). After excluding one pregnancy without detailed clinical information, there were 42 live births (5 in 22-27 weeks, 11 in 28-33weeks, 20 in 34-36 weeks, and 6 in 37-38 weeks), 13 miscarriages, and 5 ongoing pregnancies. While there were 10 first trimester miscarriages, 3 pregnancies ended in the second trimester owing to chorioamnionitis. The mean gestational age at birth was 33 weeks of pregnancy. Thirty-seven neonates were appropriate-for-date, and one was small-for-date. Six pregnancies exhibited massive bleeding from the residual cervix in the late pregnancy. Preterm birth less than 34 weeks of pregnancy was related to premature rupture of the membrane (P < 0.05). Chorioamnionitis was evident in 9 of 11 pregnancies with preterm premature rupture of the membrane followed by birth at less than 34 weeks of pregnancy. No parturients exhibited lochiometra and endometritis postpartum.
  
  
  CONCLUSIONS
  Abdominal RT provided favorable pregnancy outcomes, and fertility treatment could be advantageous to conception. Massive bleeding from the residual cervix as well as ascending infection might be characteristic features during pregnancy after abdominal RT.
authors.affiliation: *Keio University School of Medicine, Tokyo, Japan; †Department of Obstetrics and Gynecology, School of Medicine, Fujita Health University, Aichi, Japan; ‡Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kasuga
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishio
authors.forename: Kei
authors.initials: K
authors.lastname: Miyakoshi
authors.forename: Suguru
authors.initials: S
authors.lastname: Sato
authors.forename: Juri
authors.initials: J
authors.lastname: Sugiyama
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Kyoko
authors.initials: K
authors.lastname: Tanaka
authors.forename: Daigo
authors.initials: D
authors.lastname: Ochiai
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Minegishi
authors.forename: Toshio
authors.initials: T
authors.lastname: Hamatani
authors.forename: Takashi
authors.initials: T
authors.lastname: Iwata
authors.forename: Tohru
authors.initials: T
authors.lastname: Morisada
authors.forename: Masaru
authors.initials: M
authors.lastname: Nakamura
authors.forename: Takuma
authors.initials: T
authors.lastname: Fujii
authors.forename: Naoaki
authors.initials: N
authors.lastname: Kuji
authors.forename: Daisuke
authors.initials: D
authors.lastname: Aoki
authors.forename: Mamoru
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011247:Pregnancy; D011256:Pregnancy Outcome; D062606:Tertiary Care Centers; D013997:Time Factors; D000069339:Trachelectomy; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*