Institutional management policy for pregnancies after abdominal trachelectomy
We checked for the presence of vaginal varices at the uterovaginal anastomotic site. Pregnant women after AT were routinely hospitalized after 30 weeks for anticipated acute bleeding from vaginal varices. The mode of delivery was determined as cesarean section and planned at 37 weeks of gestation if the pregnancy progressed uneventfully. Cesarean section was routinely performed because a permanent cervical cerclage was placed during abdominal trachelectomy.
If threatened preterm delivery due to frequent uterine contractions was suspected on cardiotocography, tocolytic agents including oral calcium channel blockers (Ca-blockers), intravenous magnesium sulfate, or ritodrine were administered as required. When pPROM occurred prior to 34 weeks of gestation, antenatal corticosteroids, and prophylactic antibiotics (ampicillin and clindamycin) were administered. When the pregnancies reached 34 weeks of gestation without spontaneous labor onset or development of clinical chorioamnionitis (cCAM) even after pPROM, a cesarean section was performed at 34 weeks of gestation. If labor commenced or cCAM was diagnosed during expectant management of pPROM, a cesarean section was immediately performed. cCAM was diagnosed by an axillary temperature >38.0 °C and at least one of the following signs: heart rate >100 bpm, serum white blood cell count >15,000/µL, and C-reactive protein level of >2.0 mg/dL. When pPROM occurred after 34 weeks of gestation, a prompt cesarean delivery was performed.