Chapter 1 - Cancer Treatment during Pregnancy
Whenever possible, pregnant patients with cancer should be treated within institutions with known expertise in managing such cases and within a multidisciplinary team including an oncologist, obstetrician, neonatologist and also a psychologist. These pregnancies should be considered at high obstetrical risk, and hence should be closely monitored. Monthly ultrasounds should be performed to monitor foetal growth, particularly in patients receiving chemotherapy or those with advanced disease. Prophylaxis of deep vein thrombosis with low molecular weight heparin could be considered, particularly in obese patients and in those older than 35 years of age, given the hypercoagulable state of pregnancy as well as the prothrombotic effect of cancer.
Every effort should be made to complete the pregnancy to term. Preterm delivery has been associated with short- and long-term adverse effects on the newborn. In addition, it has no positive implications on maternal prognosis. In cases in which waiting until full term is not possible, later preterm delivery (i.e. starting week 35) could be an alternative.
Delivery should be avoided during nadir periods in patients receiving systemic chemotherapy. In patients treated with 3-weekly regimens, chemotherapy should be avoided after the 34th week of gestation, as these regimens have relatively long nadir periods. Weekly regimens have shorter nadir periods and hence could be administered closer to term, if needed. Regardless of the chosen regimen, blood counts, liver and kidney functions tests should be performed prior to each chemotherapy administration.
In patients who need chemotherapy shortly after giving birth, vaginal delivery should be preferred to caesarean section, as recovery following vaginal delivery is typically faster. Vital signs, weight, height, head circumference and Apgar score of all neonates should be checked.
Long-term foetal follow-up is highly recommended and this would be better performed through any of the currently available registry programmes (www.cancerinpregnancy.org or www.pregnantwithcancer.org).