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Cancer in pregnancy: maternal and fetal implications on decision-making
European Journal of Gynaecological Oncology
|March 31, 2011
Summary
Cancer during pregnancy is rare, but treatment can be successful. Platinum-based chemotherapy in the second or third trimester showed comparable newborn outcomes to the general population, suggesting treatment delay for early-stage cancer is viable.
Area of Science:
- Obstetrics and Gynecology
- Oncology
- Perinatal Medicine
Background:
- Cancer complicates approximately 1 in 1,000 pregnancies.
- Standardized therapeutic interventions for cancer during pregnancy are lacking.
- This study examines outcomes for pregnant patients diagnosed with cancer.
Purpose of the Study:
- To evaluate the safety and efficacy of cancer treatments during pregnancy.
- To assess the impact of chemotherapy on fetal development and newborn outcomes.
- To determine optimal timing for cancer treatment in pregnant patients.
Main Methods:
- Retrospective analysis of 15 pregnant patients diagnosed with cancer between 6.5 and 36 weeks gestational age (1991-2007).
- Review of treatment modalities including surgery and platinum-based chemotherapy (cisDDP).
- Assessment of maternal and neonatal outcomes, including congenital malformations, Apgar scores, and long-term follow-up.
Main Results:
- One patient opted for pregnancy termination; two declined chemotherapy initially.
- Seven patients had surgery in the first or second trimester; two delayed treatment until after delivery.
- Platinum-based chemotherapy, initiated between 18.3 and 29.6 weeks, resulted in no congenital malformations or abnormal Apgar scores in newborns. One case of preterm prelabor rupture of membranes (pPROM) occurred.
- All children were healthy at follow-up. Maternal survival was 11/15, with one living with disease. Three patients with advanced cancer died.
Conclusions:
- Platinum-based chemotherapy during the second and third trimesters is associated with newborn adverse effects comparable to the general population.
- Delaying cancer treatment to improve fetal viability or outcome may be a reasonable strategy for early-stage cancers.
- Multidisciplinary management is crucial for optimizing maternal and fetal outcomes in pregnancy complicated by cancer.
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