Obstetric outcomes of pregnancy after conservative treatment of endometrial cancer: case series and literature review

Objective: To evaluate the pregnancy courses and obstetric outcomes in patients conceived after conservative treatment of endometrial cancer.

Materials and methods: Case series and systemic review of pregnancy women after fertility-sparing treatment of endometrial cancer. Patients with early stage endometrial cancer were identified through Tumor Registry in Chang Gung Memorial Hospital between 1990 and 2005 and MEDLINE search. Diagnosed cases were managed by fertility-sparing therapies. Pregnancies followed by assisted reproductive technology and spontaneous or ovulation with intrauterine insemination were designated as Group 1 and Group 2, respectively.

Results: Five livebirths in three patients with two sets of twin pregnancy were delivered. Adding 47 women in the MEDLINE search literature, there were 65 deliveries with 77 livebirths. Groups 1 and 2 had 15 and 50 deliveries, respectively. Group 1 had 23 livebirths including four sets of twins and two sets of triplets, whereas 54 livebirths consisted of two sets of twins and one set of triplets were noted in Group 2 (p = 0.003). Seven preterm deliveries were noted in Group 1 and three in Group 2 (p = 0.001). Cesarean rate was 93.3% versus 22.0% (p < 0.001) in Groups 1 and 2, respectively. Pregnancy-induced hypertension and gestational diabetes mellitus were significant between the two groups (p = 0.035). One mother died of disease after delivery. No neonatal morbidity was reported.

Conclusions: For women who had completed conservative treatments in early endometrial cancer, assisted reproductive technology provided a choice of scheduled conception for those with subfertility or chronic anovulation.