Introduction/Background Cervical cancer during pregnancy is rare, with an incidence rate of 0.1–12.0 per 10,000 pregnancies. Although the incidence of peripartum hysterectomy is increasing due to placenta accreta spectrum, peripartum radical hysterectomy remains an infrequently performed procedure.
Methodology A retrospective review of peripartum hysterectomies that occurred in a tertiary unit from 2011–2021. Patients who had a peripartum radical hysterectomy were included.
Results In total, 23 peripartum hysterectomies were performed (incidence of 0.8 hysterectomies per 1000 deliveries). Of these, 2 (8.7%) were radical hysterectomies for cervical squamous cell carcinoma (SCC).
Patient one is a 37-year-old woman diagnosed with cervical SCC at 29 weeks gestation in 2015. MRI demonstrated a 1.6cm cervical lesion, without parametrial involvement. A radical hysterectomy and pelvic lymph node dissection was performed at 35+6 weeks gestation, with 800ml blood loss. Post-operative course was complicated by vault dehiscence requiring re-suturing. This was FIGO stage 1B2 with positive lymph nodes and the patient received adjuvant chemoradiotherapy.
Patient two is a 35-year-old woman diagnosed with cervical SCC at 29 weeks gestation in 2017. MRI revealed a 4cm cervical lesion with an indeterminate left pelvic sidewall node. A radical hysterectomy and pelvic lymph node dissection was performed at 36+1 weeks gestation, with 400mls blood loss. Post-operative course was uncomplicated. This was FIGO stage 1B2 with LVSI and the patient received adjuvant chemoradiotherapy.
Both women had healthy babies and neither have had disease recurrence. Long term, patient one has had issues with lymphoedema and the second has had issues secondary to pelvic radiation.
Conclusion Given the third trimester diagnosis in both cases, pregnancy was continued until 36 weeks balancing the risks to maternal health and prematurity. Peripartum radical hysterectomy is a rarely performed procedure. Timely involvement of the MDT is essential, to tailor management in such unique circumstances.
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