Department of Obstetrics and Gynecology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Acta Obstet Gynecol Scand. 2021 Jul;100(7):1322-1325. doi: 10.1111/aogs.14158. Epub 2021 Apr 12.
Women who have undergone radical trachelectomy as a fertility-sparing treatment for early-stage cervical cancer may be at higher risk for retained tissues after early-term miscarriage due to cervical cerclage or cervical necrosis. Dilatation and curettage or aspiration may present additional risks in these women. The aim of this study was to assess the efficacy of expectant management for early pregnancy miscarriage after radical trachelectomy.
Keio University Hospital records were reviewed for women who conceived after abdominal radical trachelectomy and received perinatal care between 1 April 2012 and 31 March 2020. A total of 62 women (76 pregnancies) were identified, and 13 of these women experienced miscarriage before 12 gestational weeks. The management and outcome of these cases were reviewed in detail.
The median maternal age at miscarriage was 39 years (range 31-42 years) and the median duration from abdominal radical trachelectomy to conception was 2.60 years (range 0.49-7.30 years). Cervical necrosis before conception occurred in one case (8%). One patient requested treatment with aspiration and the remaining 12 cases were managed with observation for a median of 23 days (range 7-50 days). There were no cases of endometritis or cases requiring dilatation and curettage for residue tissue. Further, no cases developed laceration of the residual cervix and no loss of cerclage sutures after discharge was noted.
Expectant management seems to be safe and appropriate for first trimester miscarriage after abdominal radical trachelectomy.
因宫颈环扎或宫颈坏死，接受根治性宫颈切除术保留生育功能治疗早期宫颈癌的女性，在早期流产后可能有更高的残留组织风险。在这些女性中，扩张和刮宫或抽吸可能会带来额外的风险。本研究旨在评估期待治疗对根治性宫颈切除术后早期妊娠流产的疗效。
回顾了 2012 年 4 月 1 日至 2020 年 3 月 31 日期间在庆应义塾大学医院接受过根治性经腹宫颈切除术并接受围产期护理的妊娠女性。共确定了 62 名女性（76 例妊娠），其中 13 名女性在 12 孕周前发生流产。详细回顾了这些病例的处理方法和结局。
流产时的母亲中位年龄为 39 岁（范围 31-42 岁），根治性经腹宫颈切除术到受孕的中位时间为 2.60 年（范围 0.49-7.30 年）。妊娠前发生宫颈坏死 1 例（8%）。1 例患者要求抽吸治疗，其余 12 例接受观察，中位时间为 23 天（范围 7-50 天）。无子宫内膜炎或因残留组织需要刮宫的病例，也无宫颈残端撕裂或出院后宫颈环扎缝线丢失的病例。
期待治疗似乎对根治性经腹宫颈切除术后早期流产安全且适用。
