Radical trachelectomy is a fertility-preserving alternative to radical hysterectomy in carefully selected young women with early-stage cervical cancer. However, in cases with subsequent severe cervical stenosis, assisted reproductive techniques can be difficult. This is a case report of a 34-year-old patient who underwent robot-assisted radical trachelectomy and cerclage for early-stage (IB2) adenosquamous carcinoma. Three months after surgery, the patient underwent ovarian stimulation using a gonadotropin-releasing hormone antagonist protocol. As it was impossible to perform transcervical embryo transfer due to the almost complete absence of the cervical opening, transmyometrial embryo transfer under ultrasound guidance was performed. This resulted in a successful singleton pregnancy. This is the first case of successful pregnancy conceived by in vitro fertilization with transmyometrial embryo transfer in a patient who had previously undergone robot-assisted radical trachelectomy.
Objective To compare the frequency of Ureaplasma-positive gastric fluid
(GF) cultures based on the cause and mode of delivery in preterm
newborns. Design Retrospective cohort study. Setting A single university
hospital in South Korea. Population Women with a singleton pregnancy who
delivered prematurely (between 23+0 and 32+0 weeks of gestation, N=464).
Methods The newborns’ GF was obtained on the day of birth via
nasogastric intubation. The frequency of Ureaplasma-positive GF cultures
was compared according to the cause and mode of delivery. Main outcome
measures Ureaplasma spp.-positivity in GF cultures. Results Ureaplasma
spp. was detected in 20.3% of the GF samples. The presence of
Ureaplasma spp. was significantly higher in the spontaneous preterm
birth group than in the indicated preterm birth group (30.2% vs 3.0%;
P < 0.001). Additionally, Ureaplama spp. was more frequently
found in the vaginal delivery group than in the cesarean delivery group,
irrespective of the cause of preterm delivery [indicated preterm birth
group (22.2% vs. 1.9%, P = 0.023); spontaneous preterm birth group
(37.7% vs. 24.2%, P = 0.015)]. Conclusions Ureaplasma spp. were
found in 20.3% of the GFs. However, only 1.9% of newborns in the
indicated preterm birth group with cesarean delivery had a
Ureaplasma-positive GF culture. Our findings support the view that the
amniotic cavity is a sterile environment before the onset of
parturition. Funding Ministry of Health & Welfare and Ministry of
Science and ICT, Republic of Korea (Grant No. HI22C1859) and the Seoul
National University Bundang Hospital Research Fund (Grant No.
14-2021-0025).
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