The reproductive outcome after fertility preserving treatment for premalignant and malignant gynecologic diseases: An experience of a tertiary care center

Abstract

Aims To evaluate the obstetric outcome of patients who had undergone fertility preserving treatment for gynecologic premalignant and malignant diseases. Method The study reviewed the pregnancy course and delivery data of 60 patients, who conceived after fertility sparing treatment for gynecologic premalignant and malignant diseases at Mansoura University Hospital from January 2012 to December 2015. Results The mean age of the studied patients was 24.9 years. The median follow up was 13 months (range:1-40).The preceding lesions included gestational trophoblastic neoplasia (GTN), 43 cases (71.7%) while early ovarian carcinoma (14 cases, 23.3 %) and least CIN III (2 cases, 3.3%) and micro-invasive cervical carcinoma (one case, 1.7%). All cases of GTN were treated with single or multiple agents' chemotherapy. The 3 cases of cervical micro-invasive carcinoma and CIN III were treated with loop electrosurgical excision procedures (LEEP). Cases with stage 1a ovarian cancer were treated with unilateral salpingo-oophorectomy with peritoneal cytology and biopsy of the other ovary. Missed abortion was diagnosed in 4 cases (6.7%). The rate of caesarean delivery (CD) was high (70.9%). Intra-abdominal adhesions during CD were seen in (20.5%) of cases. The neonatal outcome was normal in 53 cases, and 2 cases (3.6%) of had congenital fetal malformations. The poor neonatal outcome was significantly correlated to number of chemotherapy cycles. Conclusion The reproductive outcome after fertility preserving treatment of GTN, micro-invasive carcinoma of cervix, CINIII, and stage 1 ovarian cancer is comparable to those of general population. However, there were increased rate of CD, Intra-abdominal adhesions, missed abortion and congenital fetal malformations.