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

Introduction 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. Material and methods Keio University Hospital records were reviewed for women who conceived after abdominal radical trachelectomy and received perinatal care between April 1, 2012, and March 31, 2020. A total of 62 women (76 pregnancies) were identified, and 13 women experienced miscarriage before 12 gestational weeks. The management and outcome of these cases were reviewed in detail. Results 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 had occurred in one case (8%). One patient requested treatment with aspiration, and the remaining 12 cases were managed with observation by a median of 23 days (range, 7-50 days). There were no cases of endometritis or cases requiring dilatation and curettage for residue. Further, no cases developed laceration of the residual cervix, and no loss of cerclage sutures after discharge was noted. Conclusions Expectant management seems to be safe and appropriate for early trimester miscarriage after abdominal radical trachelectomy.