Highlight
- •Oral metronidazole and no intercourse may reduce premature birth after trachelectomy.
- •A short post-trachelectomy cervical lenght may impair fertility.
Abstract
Objectives
Women with a previous trachelectomy have an increased risk of premature delivery and
second trimester miscarriage. In this study we aim to evaluate factors and regimes
possibly affecting the risk for prematurity following fertility sparing robotic radical
trachelectomy (RRT) in cervical cancer.
Methods
A retrospective study of the reproductive outcome following RRT with a cervical cerclage
performed at one of four academic centers between 2007 and 2019. Factors possibly
related to premature delivery, such as postoperative non-pregnant cervical length,
previous vaginal deliveries, preservation of the uterine arteries, and the use of
a second trimester oral metronidazole/no sexual intercourse regime, were assessed.
Results
109 women remained for analyses after excluding recurrences before pregnancy (n = 8), secondary hysterectomy (n = 2), and women with less than six months follow up (n = 10). 74 pregnancies occurred in 52/71 women attempting to conceive, 56 of which
developed past the first trimester. Two of 22 women (9%) who were prescribed an oral
metronidazole regime (400 mg × 2 from gestational week 15 + 0 to 21 + 6 and abstaining
from sexual intercourse for the duration of the pregnancy) had a premature delivery,
compared with 13/31 (42%) where the regime was not applied (p = 0.009). The association remained after regression analyses including possible contributing
factors as of above, none of which associated with prematurity at regression analyses
(p = 0.001).
Conclusions
The observed four-fold reduction in premature delivery indicates that an oral metronidazole/no
sexual intercourse regime may reduce second trimester miscarriage and premature deliveries
following an RRT. No association was observed for other investigated factors.
Keywords
Abbreviations:
RT (radical trachelectomy), VRT (vaginal radical trachelectomy), ART (abdominal radical trachelectomy), LRT (laparoscopic radical trachelectomy), RRT (robot-assisted radical trachelectomy), SUH (Skåne University Hospital), KUH (Karolinska University Hospital), YUHS (Severance Hospital of the Yonsei University), RSCH (Royal Surrey County Hospital), LVSI (Lymphovascular space invasion), GW (Gestational week), BV (Bacterial vaginosis)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 24, 2021
Accepted:
August 22,
2021
Received in revised form:
August 1,
2021
Received:
June 7,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
