In a groundbreaking medical procedure, four women in the UK successfully underwent a combined surgery, in which they gave birth by caesarean section (C-sec) and at the same time had surgery to reduce their risk of ovarian cancer.

The women were all carriers of the BRCA1 or BRCA2 gene alterations, which puts them at a lifetime higher risk of ovarian cancer. 

Risk-reducing surgery for these patients, known as a bilateral salpingo-oophorectomy (RRSO), is the only proven way to reduce ovarian cancer mortality. It reduces ovarian cancer risk by at least 95 per cent.

Usually it is a standalone procedure, where the fallopian tubes and ovaries are removed. The first such case of a C-sec with the risk-reducing RRSO to reduce ovarian cancer risk was done in 2018 by a team at the University College London Hospital (UCLH). 

However, the study, published in Obstetrics and Gynecology details case reports of four women, carrying the BRCA gene alteration and who were due to have a C-sec. 

All four women, between 40 and 45 years old, were receiving maternity care at UCLH between March 2018 and March 2022. To be considered for the procedure, the women had to be over 35 or 40 years old for the BRCA1 and BRCA2 alterations respectively, and not planning any further children.

All four surgeries went well and none of the women had serious post-surgical complications, said the researchers at UCLH. 

Patients did not need to stay in hospital any longer than they would have after a C-sec alone. There is a theoretical possibility of greater blood loss with risk-reducing surgery at the time of C-sec delivery — but there was no evidence that this was a problem in these cases.