Management of pregnancy after fertility‐sparing surgery for cervical cancer

Abstract

Cervical cancer is increasingly diagnosed in women who have not yet completed their reproductive plans. For patients with early stages (FIGO stage IA2 and IB1), fertility‐sparing procedures, such as conization, trachelectomy or radical trachelectomy, represent the treatment of choice. However, patients who undergo repeated conization or trachelectomy represent a challenge for obstetricians as they are at increased risk of infertility, mid‐trimester abortion, 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 patients 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 prior history of preterm delivery or late miscarriage may benefit from cervical cerclage. Elective delivery by cesarean section in the early‐term period is desirable.