Chemotherapy for Gynecologic Cancers Occurring During Pregnancy

Abstract

After completing this CME activity, physicians should be better able to specify the indications for chemotherapy in gynecologic cancers during pregnancy and postpartum periods, discuss the risks and benefits of chemotherapy for gynecologic cancer during pregnancy and postpartum periods. In addition, they should also be able to distinguish the mechanism of action of various chemotherapy agents to choose the best treatment options for patients and monitor for impacts of chemotherapy on fetal growth to determine the best treatment and management strategies.

Germ cell cancer in pregnancy – Successfully treated with chemotherapy and surgery

“…Chemotherapy in pregnancy must be a balance between maternal benefit and risk to the foetus – Delay in treatment is likely to have an adverse effect on prognosis. Chemotherapy in the first trimester is not recommended due to high risk of foetal teratogenicity and major malformations occurring in up to 20% pregnancies ( Ko and Van Le, 2011 , He et al, 2022 ). Additionally, chemotherapy should be avoided in the last few weeks of gestation due to risk of infection and bleeding during delivery secondary to maternal myelosuppression.…”

“…Due to rarity and ethical considerations, there are no randomised controlled trials nor prospective studies for chemotherapy in pregnancy. Intrauterine growth restriction and low birth weight are suggested to be the most common foetal complications following chemotherapy ( Ko and Van Le, 2011 ).…”

Ethical Principles Do Not Support Mandatory Preanesthesia Pregnancy Screening Tests: A Narrative Review

“…(2) the surgical/operative procedure involves significant radiation to the pelvis or gravid uterus (procedures involving radiation of other anatomic regions do not require verification of pregnancy status) 63 ; (3) administration of chemotherapy during surgery 64,65 ; and (4) the surgical procedure involves significant manipulation of pelvic organs. 26,66 ACCURACY OF PREGNANCY TESTING In the United States, 0.3% to 2.2% of pregnant patients undergo non-obstetric surgery annually.…”

“…Anesthesiologists are not responsible for ordering pregnancy tests for nonanesthesia indications, but they should know what surgeries can potentially involve a surgeon-ordered pregnancy test, evaluate the results of any pregnancy test, and address anesthesia risks and benefits with the patient. Indications for a surgeon to request a pregnancy test include the following: (1) the presence of pregnancy would obviate the need for surgery (eg, the patient is undergoing a fertility procedure, but is unexpectedly pregnant); (2) the surgical/operative procedure involves significant radiation to the pelvis or gravid uterus (procedures involving radiation of other anatomic regions do not require verification of pregnancy status) 63 ; (3) administration of chemotherapy during surgery 64,65 ; and (4) the surgical procedure involves significant manipulation of pelvic organs. 26,66…”