Cervical cancer diagnosed shortly after pregnancy: Prognostic variables and delivery routes

Objective: To compare the prognoses of women diagnosed with cervical cancer during pregnancy with the prognoses of those diagnosed within 6 months aft er delivery and to assess the effect of vaginal delivery on recurrence risk and prognosis. Methods: A matched case-control study of women with cervical cancer diagnos ed during pregnancy or within 6 months of delivery was performed. Fifty-six women had cervical cancer diagnosed during pregnancy and 27 within 6 month s after delivery. Controls (cervical cancer diagnosed at least 5 years sinc e last delivery) were matched one-to-one with cases based on age, histology , stage, treatment, and time of treatment. Results: Among postpartum women, four had stage IA disease, 15 had stage IB 1 or IB2, and eight had stage IIA or higher disease. Eleven had radical hys terectomies and 14 had radiation therapy. Two with stage IA1 disease were t reated with vaginal hysterectomies. One of seven patients who had cesareans developed a local and distant recurrence. In contrast, ten of 17 (59%) who delivered vaginally developed recurrences (P = .04). In multivariate analy sis, vaginal delivery was the most significant predictor of recurrence (odd s ratio [OR] 6.91; 95% confidence interval [CI] 1.45, 32.8), followed by hi gh stage (OR 4.66; 95% CI 1.05, 20.8). The survival for patients diagnosed in the postpartum period was significantly worse than for controls. Conclusion: Women diagnosed postpartum had worse survival than those diagno sed during pregnancy and were at significant risk of recurrent disease, par ticularly if they delivered vaginally. Therefore, pregnant women with cervi cal cancer should be delivered by cesarean. (Obstet Gynecol 2000;95:832-8. (C) 2000 by The American College of Obstetricians and Gynecologists).