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

Abstract

OBJECTIVE: 

To evaluate outcomes of the first pregnancy after fertility-sparing surgery in patients with early-stage cervical cancer.

METHODS: 

We performed a population-based study of women aged 18–45 years with a history of stage I cervical cancer reported to the 2000–2012 California Cancer Registry. Data were linked to the OSHPD (California Office of Statewide Health Planning and Development) birth and discharge data sets. We included patients with cervical cancer who conceived at least 3 months after a fertility-sparing surgery, which included cervical conization or loop electrosurgical excision procedure. Those undergoing trachelectomy were excluded. The primary outcome was preterm birth. Secondary outcomes included growth restriction, neonatal morbidity, stillbirth, cesarean delivery, and severe maternal morbidity. We used propensity scores to match similar women from two groups in a 1:2 ratio of case group participants to control group participants: population individuals without cancer and individuals with cervical cancer (women who delivered before their cervical cancer diagnosis). Wald statistics and logistic regressions were used to evaluate outcomes.

RESULTS: 

Of 4,087 patients with cervical cancer, 118 (2.9%) conceived after fertility-sparing surgery, and 107 met inclusion criteria and were matched to control group participants. Squamous cell carcinoma was the most common histology (63.2%), followed by adenocarcinoma (30.8%). Patients in the case group had higher odds of preterm birth before 37 weeks of gestation compared with both control groups (21.5% vs 9.3%, odds ratio [OR] 2.7, 95% CI 1.4–5.1; 21.5% vs 12.7%, OR 1.9, 95% CI 1.0–3.6), but not preterm birth before 32 weeks. Neonatal morbidity was more common among the patients in the case group relative to those in the cervical cancer control group (15.9% vs 6.9%, OR 2.5, 95% CI 1.2–5.5). There were no differences in rates of growth restriction, stillbirth, cesarean delivery, and maternal morbidity.

CONCLUSION: 

In a population-based cohort, patients who conceived after surgery for cervical cancer had higher odds of preterm delivery compared with control groups.

In Brief

Patients with cervical cancer who underwent fertility-sparing surgery had an increased risk of preterm birth and neonatal morbidity compared with matched participants in control groups.