BACKGROUND AND PURPOSE:

• Data on pregnancy outcomes among patients with early-stage cervical cancer who have undergone fertility-sparing surgery are limited
• Nitecki et al. (Obstetrics & Gynecology, 2021) evaluated outcomes of the first pregnancy after fertility-sparing surgery in patients with early-stage cervical cancer

METHODS:

• Population-based study
• Population
  • 18 to 45 years
  • History of stage I cervical cancer who conceived at least 3 months after a fertility-sparing surgery
  • Acceptable surgeries
    • Cervical conization
    • Loop electrosurgical excision procedure
  • Excluded surgeries: Trachelectomies
• Exposures
  • Case group: Patients with cervical cancer and fertility sparing surgery
  • Cancer control group: Patients with cervical cancer who delivered before their diagnosis
  • Population control group: Individuals without cancer
• Study design
  • Propensity scores were used to match similar women from two groups in a 1:2 ratio of case group participants to control group participants
  • Logistic regressions were used to evaluate outcomes
• Primary outcome
  • Preterm birth (<37 weeks)
• Secondary outcomes
  • Growth restriction
  • Neonatal morbidity
  • Stillbirth
  • Cesarean delivery
  • Severe maternal morbidity

RESULTS:

• Case patients: 107 | Population control patients: 214 | Cancer control patients: 173
  • Squamous cell carcinoma: 63.2%
  • Adenocarcinoma: 30.8%
• Patients in the case group had higher odds of preterm birth (<37 weeks) vs either control group
  • Case group: 21.5%
  • Population control group: 9.3%
  • Cancer control group: 12.7%
  • Case vs population
    • OR 2.7 (95% CI, 1.4 to 5.1)
  • Case vs cancer controls
    • OR 1.9 (95% CI, 1.0 to 3.6)
• However, there was no difference in odds of preterm birth <32 weeks among the groups
• Neonatal morbidity was more common among the patients in the case group relative to those in the cervical cancer control group
  • Case group: 15.9%
  • Cancer control group: 6.9%
  • OR 2.5 (95% CI, 1.2 to 5.5)
• There were no differences among the groups for rates of the following
  • Growth restriction | Stillbirth | Cesarean delivery | Maternal morbidity

CONCLUSION:

• Patients with a history of stage 1 cervical cancer who conceived after fertility-sparing surgery experienced higher odds of preterm birth before 37 weeks
  • However, there was no difference in rates of preterm birth prior to 32 weeks
• The authors state

This study provides evidence to foster shared decision-making discussions regarding obstetric outcomes after fertility-sparing treatment for early cervical cancer

With greater knowledge of these risks and close antenatal surveillance, there may be room for intervention to prolong gestation and achieve more favorable neonatal outcomes

Learn More – Primary Sources:

Outcomes of the First Pregnancy After Fertility-Sparing Surgery for Early-Stage Cervical Cancer

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