Reproductive and Perinatal Outcomes After Trachelectomy: Vaginal Microbiota and Early Preterm Birth.

OBJECTIVE

To evaluate reproductive and perinatal outcomes in patients who underwent trachelectomy for early-stage cervical cancer, focusing on predictors of pregnancy achievement and early preterm birth.

METHODS

This retrospective cohort study included 37 patients who underwent trachelectomy between January 2010 and February 2025, with perinatal follow-up and delivery management at Kyoto University Hospital. Reproductive outcomes were analyzed in 20 patients who desired pregnancy and received infertility treatment. Perinatal outcomes were assessed in 17 deliveries, comparing 22-33 weeks and ≥ 34 weeks. Clinical variables were compared between groups using the Mann-Whitney U test and Fisher's exact test.

RESULTS

Among patients who underwent infertility treatment, 15 (75.0%) achieved at least one clinical pregnancy and 12 (60.0%) achieved live birth. Higher gravida at treatment initiation was significantly associated with pregnancy achievement. Among 17 deliveries, 7 occurred between 22 and 33 weeks and 10 at ≥ 34 weeks. Cervical length before pregnancy and at 22 weeks of gestation did not differ between groups. In contrast, the Nugent score was significantly higher in the 22-33-week group (p = 0.0414), and preterm premature rupture of membranes occurred in all pregnancies in this group versus 40% in the ≥ 34-week group (p = 0.0108).

CONCLUSIONS

Vaginal microbiota imbalance was significantly associated with early preterm birth after trachelectomy. These findings suggest that ascending infection due to impaired cervical barrier function may contribute to this risk. Prospective studies incorporating longitudinal microbiota profiling and targeted intervention are warranted.