Almost 1 % of all cervical cancers occur in pregnant women. The recommended management during the first 20 weeks is to sacrifice the pregnancy and to perform standard therapy, which means the loss of future fertility. A trachelectomy during pregnancy could preserve the ongoing pregnancy and future fertility. The author reports a radical vaginal trachelectomy (RVT) during 18 weeks of pregnancy. Definitive pathology of the trachelectomy specimen showed a tumor of 48 millimeters. Subsequently a radical hysterectomy was performed. At present, eight years and six months later the patient is well with no signs of recurrence. RVT is feasible in the first and second trimester of pregnancy. Clinical examination and MRI however are less accurate in the evaluation of stage and the extent of the tumor during pregnancy. Converting a RVT to a radical hysterectomy in a second time is safe in a pregnant woman.