Late miscarriage and premature delivery after fertility spar
Oral metronidazole and abstaining from sexual intercourse may reduce the risk for premature birth in women with a previous trachelectomy.

Women with a previous trachelectomy have an increased risk of premature delivery and second-trimester miscarriage. In this study, researchers aim to evaluate factors and regimes possibly affecting the risk for prematurity following fertility-sparing robotic radical trachelectomy (RRT) in cervical cancer.

A retrospective study of the reproductive outcome following RRT with a cervical cerclage was performed. Factors possibly related to premature delivery, such as postoperative non-pregnant cervical length, previous vaginal deliveries, preservation of the uterine arteries, and the use of a second-trimester oral metronidazole/no sexual intercourse regime, were assessed.

109 women remained for analyses after excluding recurrences before pregnancy, secondary hysterectomy, and women with less than six months follow-up. 74 pregnancies occurred in 52/71 women attempting to conceive, 56 of which developed past the first trimester.

- Two of 22 women who have prescribed an oral metronidazole regime had a premature delivery, compared with 13/31 where the regime was not applied.

- The association remained after regression analyses including possible contributing factors as of above, none of which were associated with prematurity at regression analyses.

In particular, the observed four-fold reduction in premature delivery indicates that an oral metronidazole/no sexual intercourse regime may reduce second-trimester miscarriage and premature deliveries following an RRT. No association was observed for other investigated factors.