From Cervical High-Grade Squamous Intraepithelial Lesion (HSIL) to Term Delivery: A Case of Pregnancy After Trachelectomy With Cerclage

TL;DR

A woman successfully delivered a healthy baby after undergoing fertility-sparing surgery for cervical cancer and having a permanent cerclage placed.

Contribution

This case highlights successful pregnancy outcomes after radical trachelectomy with permanent cerclage in early-stage cervical cancer.

Findings

The patient conceived spontaneously two years after fertility-sparing surgery.

She delivered a healthy full-term neonate via elective caesarean section at 37 weeks.

Multidisciplinary care and close monitoring were key to managing the pregnancy.

Abstract

Cervical cancer remains one of the most common malignancies affecting women, with a significant proportion of cases diagnosed during reproductive age. Fertility-sparing approaches, such as radical trachelectomy, have emerged as viable alternatives to radical hysterectomy in selected early-stage cases, allowing preservation of reproductive potential without compromising oncological outcomes. The placement of permanent cerclage has been associated with improved obstetric results. We present a case of a nulliparous woman in her 30s initially managed for persistent high-grade squamous intraepithelial lesion (HSIL), corresponding histologically to cervical intraepithelial neoplasia grade 2/grade 3 (CIN2/CIN3), despite multiple conizations with clear margins. Following oncological referral, she was diagnosed with FIGO ( International Federation of Gynecology and Obstetrics) stage 1B1 cervical cancer and underwent radical trachelectomy with colpectomy, pelvic lymphadenectomy, and placement of a permanent cerclage. Two years later, she conceived spontaneously. Apart from an episode of threatened preterm labor at 28 weeks requiring surveillance and fetal lung maturation, the pregnancy progressed without other major complications. An elective caesarean section at 37 weeks resulted in the delivery of a healthy full-term neonate. This case illustrates the potential for successful term pregnancy following fertility-sparing surgery with permanent cerclage in carefully selected patients, emphasizing the importance of multidisciplinary management and close obstetric surveillance.

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