Successful pregnancy after PPROM & Radical Trachelectomy

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Successful pregnancy after PPROM & Radical Trachelectomy

by Corks73 on Sat Aug 14, 2010 09:20 PM

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Hi there -

I had a radical trachelectomy in January 2008. Thankfully my lymph nodes were negative and I did not receive further cancer treatment. However, I continue to be monitored every 3-4 months.

In July 2009 I successfully conceived and unfortunately I lost the baby at 21 weeks due to PPROM. I found out later that 2nd trimester pregnancy loss is one of the main pregnancy risk factors for a female who has had a RT.

My husband and I have started trying again and I am wondering if there are any ladies out there who have had a RT, a 2nd or 3rd trimester pregnancy loss and then have gone on to have healthy babies?

Thanks!

RE: Successful pregnancy after PPROM & Radical Trachelectomy

by sange1 on Wed Sep 01, 2010 06:29 AM

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I am glad that I have found this site.  It gives me some comfort dealing with the grief that I am feeling.  11 years ago I had a radical trachelectomy and have been cancer free since.  Unfortunatley it had been very difficult for us to conceive.  I had a shunt surgically put in the opening of what was left of my cervix in hopes that I would be able to have IUI treatments. We did about 8 treatments and did not become pregnant so we gave up as it was very emotional on us both.  Well fast forward to May of this year and we found out that we were expecting!!! We were over the moon. We were finally having our miracle baby. There was some minor bleeding at 6 weeks and then again at 12 weeks, but otherwise our baby boy was developing normal and there were no other problems.  I went for my first appointment at the high risk clinic at 12 weeks, but my next appointment would not be until 17 weeks gestation. Well we never made it to our next appointment.  At 16 weeks I had some minor bleeding and cramping so we decided to go to the hosptital.  We were sent to our high risk specialist as the OB on call had never seen a patient with-out a cervix.  On the saturday we were told my cervix looks exactly the way it is suppose to look and sent on our way.  2 days later we were back because the bleeding and cramping had not stopped.  I was admitted and told that they would need to terminate the pregnancy because I was 1 cm dilated and my stitch in my cervix was tearing.  I had not leaked any fluid and our baby was still under no stress, moving and kicking all the way to the operating room.  So 5 days after our whole ordeal started we lost our baby boy.  I am very angry at this point because I feel like more should have been done, we should have been followed more closely.  I now have a follow up appointment on Friday and will be asking about an abdominal stitch. I am very curious if it would be benificial to have 2 stitches in place. It is very frustrating that there is not alot of information on pregnancy after radical trachelectomy and the management of pregnancy.  Hopefully we will get the answers we are looking for and it will give us hope to try again.  I wish you luck with your journey.

RE: Successful pregnancy after PPROM & Radical Trachelectomy

by Corks73 on Wed Sep 01, 2010 12:51 PM

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Dear Sange1 -

I am so sorry for your loss. I know what you have gone through and it is so incredibly difficult. You should feel no guilt though - there is nothing you could have done differently and you certainly didn't ask to have cancer and a radical trachelectomy!

I have been told that the success rates for pregnancy will go up with a abdominal cerclage but I would be curious what you hear. I have not had a consultation with a doctor about it so I am hearing everything second hand.

May I ask how old you are? I am 37 so my fertility issues are being compounded by my 'advanced' age. Gosh - when did things get so hard???

RE: Successful pregnancy after PPROM & Radical Trachelectomy

by sange1 on Wed Sep 01, 2010 10:00 PM

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Thank you so much.  This has been a very hard 2 weeks.  I am just very angry right now, for 11 years I woundered if I would ever become pregnant again and we were given this amazing gift only for it to be taken from us.  I feel helpless because there was nothing that I could have done. I can't help but to wonder if the doctor's knew more about my surgery could they have done more?  I have been trying to find out as much information as possible for when I have my follow up appointment on Friday.  I am even in touch with my original surgeon in Toronto and he is also trying to get as much information as he can for me from the doctor's here on what went wrong and what we can do different next time shoudl I become pregnant again. 

From what I have read the success rates are better with the abdominal stitch, I hope that when I go on Friday they will be agreeable to do this for me.  The stitch that I have was done vaginally and that is what was tearing so I had to deliver.

I am 37 years old as well.  We have done all the fertility testing and that is not an issue with us, the issue is my cervix is closed so tight that conception is almost impossible.

I know that healthy, almost term and term pregnancies are possible and I am really wanting to try again, but my husband is very against it right now.  He is so scared that something will happen to me and ofcoarse we would never want to experience this heart ache again.

Again, Thank you for your email.  I wish you luck and I would really like toknow how things are going for you.  At this moment I feel very alone because not many people can say "I know how you feel"

Take care

RE: Successful pregnancy after PPROM & Radical Trachelectomy

by mobilis on Wed Sep 29, 2010 11:09 PM

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I'm sorry to hear of your losses. I haven't suffered a pregnancy loss, but my baby daughter was born with a congenital heart/lung defect and died, and I know that the loss of a child is the hardest thing to bear.

I had a radical trachelectomy and lymphadenectomy on 24 September 2008. It was a complete removal of the cervix, with no cervical stub left. An abdominal cerclage was placed over the lower uterine segment to form a "neo-cervix".

After a number of failed IUIs I had a laparoscopy and discovered that my tubes had been damaged, probably as a result of the lymphadenectomy. One was repaired, but after a further failed IUI and "natural" IVF during a cycle where I ovulated on the wrong side, I did a long course IVF and transferred one embryo, which resulted in a pregnancy. I am also 37 - I was 36 at the time - and didn't want to delay in view of the risk of mid-trimester loss.

My baby boy was born by c-section at 37w5d on 12 July 2010. I was on antibiotics (flagyl and augmentin) from the 14th week of pregnancy as well as adalat and arthrexin as off-label tocolytics. I was also on progesterone support for the duration of the pregnancy.

My obstetrician commented at my 24 week scan that the strain on the cerclage was apparent and that without it I would certainly have lost the pregnancy between 20 and 24 weeks, if not sooner. He did not feel that a successful pregnancy would be possible without a cerclage in a patient like me with no cervical stub remaining.

I'm surprised that the risks of pregnancy after RT weren't discussed with you, and that an abdominal cerclage wasn't offered at the time of the RT. It can be placed in addition to a vaginal cerclage (McDonald or Shirodkar) and can even be placed during a pregnancy.

I would encourage you to investigate an abdominal cerclage - www.abbyloopers.com is a good resource. In addition, I would choose an obstetrician who specialises in high risk pregnancies (eg multiple pregnancies and incompetent cervix), even if s/he hasn't managed a trachelectomy patient before.

All the best further - please let me know if you have any other questions. If you search "trachelectomy" on this site you will find a long thread on pregnancy after trachelectomy, with a number of success stories.

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