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Case Reports: Novel treatment (new drug/interventions; established drug/procedure in new situation)
Successful term pregnancy following cervical cerclage for uterine atrophy secondary to childhood radiotherapy
  1. Anastasia Martin,
  2. Natalie Suff and
  3. Andrew Shennan
  1. Department of Women and Children's Health, King's College London, London, UK
  1. Correspondence to Dr Natalie Suff; natalie.suff{at}kcl.ac.uk

Abstract

Pelvic radiotherapy can lead to scarring and atrophy of reproductive organs including the uterus. This may lead to complications, such as preterm birth, during pregnancy. The mechanism by which preterm birth is associated with pelvic radiation is believed to be due to inefficient uterine stretch or a deficient cervix. We report a case of cervical shortening during the second trimester in a pregnant woman with a history of pelvic radiotherapy in childhood. Ultrasound surveillance and cervical cerclage inserted in the shortening cervix successfully prevented preterm labour in this case. Cerclage insertion led to a longer cervix and lower fibronectin. Although cervical cerclage does not influence uterine stretch, it may be able to prevent cervical dilatation and therefore prevent ascending infections and subsequent inflammatory sequelae which results in preterm labour. We recommend cervical surveillance and targeted cerclage interventions to prevent preterm labour in women with prior childhood pelvic radiotherapy.

  • reproductive medicine
  • obstetrics and gynaecology

http://dx.doi.org/10.1136/bcr-2022-249452

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    Footnotes

    • Contributors AM has contributed to the review of the literature and major contributor in writing the manuscript. NS contributed to the writing and editing of the manuscript. AS has overseen the write up of the manuscript and contributed with the editing of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.