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

Background: Treatment of gynecologic cancers in young women is a real challenge as obtaining the future women's fertility is almost always keened by the patient and her family. However, there are reported adverse outcome of pregnancy after treatment. Objective: To evaluate the obstetric outcome of patients who had undergone fertility preserving treatment for gynecologic premalignant and malignant diseases. Patients and methods: 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 department of Obstetrics and Gynecology and department of Clinical Oncology & Nuclear Medicine at Mansoura University Hospital from January 2012 to December2015. We reported pregnancy complications, abnormalities during labor, neonatal outcome and any recurrence after delivery. Results: The mean age (± SD) of the studied patients was 24.9 (± 6.03) years. The median follow upwas 13 months (range:!-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 la 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 CDwere 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 (P=0.04).
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