Abnormal menstruation after radical trachelectomy and its effects on fertility

Abstract

Aim: To evaluate and identify the risk factors for abnormal menstruation after radical trachelectomy. Methods: This study included 58 patients who underwent radical trachelectomy at our hospital between April 2005 and January 2018. Patients were divided into groups of those with no change in postoperative menstruation (regular [R] group; n = 46) and those with abnormal menstruation such as amenorrhea or hypomenorrhea (irregular [I] group; n = 12). The perioperative characteristics and fertility of the groups were compared retrospectively. The data were statistically analyzed using Student's t-test, Fisher's exact test and Mann-Whitney U test for univariate analysis and logistic regression analysis for multivariate analysis, with the level of statistical significance set at P < 0.05. Results: Based on Federation of Gynecology and Obstetrics staging, 54 patients had stage IB1, 2 had stage IB2 and 2 had stage IIA1 cervical cancer. Eight patients received neoadjuvant chemotherapy. Pretreatment tumor size, residual uterine cavity length and neoadjuvant and postoperative chemotherapy use were not significantly different between the groups. Abnormal menstruation was significantly more common in patients with postoperative pelvic infection (R group, 13.0%; I group, 58.3%) and cervical stenosis (R group, 15.2%; I group, 58.3%). Conclusion: To maintain healthy menstruation even after radical trachelectomy, it is important to prevent postoperative pelvic infection and cervical stenosis.

Management of pregnancy after radical trachelectomy

“…This may often lead to development of residual cervical necrosis [6]. The residual cervical cavity may thus become narrowed, often leading to abnormal menstruation in patients following RT [7]. In cases with early miscarriage with no history of RT, dilatation and curettage (D&C) is usually performed [8].…”

Expectant management for early pregnancy miscarriage after radical trachelectomy: A single hospital‐based study

“…However, women who undergo RT also have simultaneous cervical cerclage to prevent future preterm delivery, and residual cervical necrosis occurs in an average of 10.5% of cases 3 . Therefore, the residual uterine cavity is often narrowed after RT, and some patients also suffer from abnormal menstruation 4 . Although dilatation and curettage (D&C) has been performed for early‐pregnancy miscarriage after RT, 5 there is concern about damaging the cervical cerclage or the possibility of developing endometritis.…”

“…3 Therefore, the residual uterine cavity is often narrowed after RT, and some patients also suffer from abnormal menstruation. 4 Although dilatation and curettage (D&C) has been performed for early-pregnancy miscarriage after RT, 5 there is concern about damaging the cervical cerclage or the possibility of developing endometritis. Bernardini et al reported that three out of three RT patients with early miscarriage did not need D&C. 5 Moreover, Plante et al reported that among eight patients with early miscarriage, five patients did not need D&C, one needed misoprostol and D&C, and one was treated using misoprostol alone; since one other patient did not abort spontaneously using misoprostol and developed endometritis and placental tissue retention, she needed to undergo D&C and take antibiotics.…”