Management of pregnancy after trachelectomy for early cervical cancer TOG 2017

Question 1

What % of women with cervical cancer are <45yrs?

Answer 1

52%

Question 2

What fertility sparing surgery can be offered in cervical cancer

Answer 2

1A1: Knife biopsy +/- Lap lymphdenectomy
IA2-IB1: Tracehelctomy

Question 3

What % of women who have had a trachelectomy required ART?

Answer 3

61%

Question 4

Rate of 1st trimester miscarriage?

Answer 4

16%

Question 5

Rate of 2nd trimester miscarriage?

Answer 5

7% (vs 4% general population)

Question 6

Risk preterm labour

Answer 6

20-30%

Question 7

% of women who delivered at term with previous tracehelectomy?

Answer 7

55%

Question 8

Risks of trachelectomy in pregnancy?

Answer 8

Cerical incompetence
Ascending infection - PPROM and chorio
Painless progressive dilatation - mid trimester miscarriage and pre term labour

Question 9

How to manage in early pregnancy

Answer 9

neo-cervoal length USS
Active screening for genital infections
No evidence for suture

Question 10

How long should wait after tracehelctomy for pregnancy?

Answer 10

6 months

Question 11

Most appropriate contraception for after trachelectomy

Answer 11

DEPO-provera

Question 12

AN care

Answer 12

• Consutlanant led ANC
• Vaginal progesterone 12-36 weeks
• 2 weekly isthmus length USS
• Test urine & vain gal cultures at 1st appoitnemt, consider prophylactic Abx 16-24 weeks
• Consider steroid from 24 weeks if signs PTL
• Avoid SI from 20 weeks to reduce risk infection
• Avoid tenuous activity
• Abx if PPROM
• Delivery by CS around 37 weeks

Question 13

Why is it advised to delivery by CS?

Answer 13

Risk of uterine rupture/severe haemorrhage
May have poorly formed lower segment, consider vertical incision