Optimising fertility outcomes for women with early-stage cervical cancer: when less is more

Radical hysterectomy and pelvic lymphadenectomy is standard management for early-stage cervical cancer. Radical trachelectomy achieves equivalent oncological outcomes to hysterectomy thus providing an alternative for women who wish to preserve their fertility (Xu et al. Acta Obstet Gynecol Scand 2011; 90: 1200-09). Trachelectomy offers the potential for pregnancy but poor obstetric sequelae, including second trimester miscarriage, preterm premature rupture of membranes (PPROM) and preterm delivery are common, likely due to reduced mechanical support from a shortened cervix and ascending infection. In this issue of BJOG, Kasuga et al. report that mid-trimester residual cervical length of <13mm is a good predictor of preterm delivery <34 weeks in women who have undergone abdominal radical trachelectomy (ART). This article is protected by copyright. All rights reserved.