Open AccessManagement of pregnancy after fertility‐sparing surgery for cervical cancer
Author(s) -
Šimják Patrik,
Cibula David,
Pařízek Antonín,
Sláma Jiří
Publication year - 2020
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.13917
Subject(s) - medicine , trachelectomy , miscarriage , obstetrics , cervical cancer , cervical cerclage , pregnancy , fertility preservation , gynecology , fertility , infertility , cancer , gestational age , population , environmental health , biology , genetics
Cervical cancer is increasingly diagnosed in women who have not yet completed their reproductive plans. For women with early‐stage disease (FIGO stage IA1‐IB1), fertility‐sparing procedures, such as conization, trachelectomy or radical trachelectomy, represent the treatments of choice. However, women who undergo repeated conization or trachelectomy represent a challenge for obstetricians because they are at increased risk of infertility, mid‐trimester miscarriage, preterm premature rupture of membranes and preterm delivery. So far, the evidence‐based guidance on the management of these pregnancies is limited. This article reviews the literature discussing pregnancy management in women after fertility‐sparing surgery for early cervical cancer. Although the evidence is limited, certain measures are desirable, including screening and treatment of asymptomatic bacteriuria, screening for cervical incompetence and progressive cervical shortening by transvaginal ultrasonography, and fetal fibronectin testing. Vaginal progesterone supplementation should be primary prevention for all women after trachelectomy. Women with a history of preterm delivery or late miscarriage may benefit from cervical cerclage. Elective delivery by cesarean section in the early‐term period is desirable.