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.