Cancer is the second leading cause of death in women of reproductive age. Pregnancy and birth in women with cancer is a psychologically, physiologically and medically sensitive issue. This book chapter deals with the diagnostic and therapeutic approaches that should be followed in women diagnosed with cancer and experiencing pregnancy, birth and postpartum period.
Diagnosis and treatment of cancers during pregnancy should be carefully planned according to trimesters in terms of both maternal and foetal health. Chemotherapy and radiotherapy in the first trimester are usually delayed because they may have teratogenic effects on the foetus. In the second and third trimesters, some chemotherapy drugs can be used more safely and uterine evacuation and hysterectomy can be performed.
Birth planning is also of special importance in women with cancer who are still pregnant. Premature delivery is avoided because of the high morbidity probability. However, preterm delivery can be planned in order to minimise the time without treatment and to prevent deterioration of the mother’s health status. Vaginal delivery is contraindicated for most cervical and vulvar cancers due to the potential for implantation of cancer cells into the vaginal laceration/episiotomy site. In addition, complications such as hysterectomy, blood transfusion, thromboembolism, sepsis may be seen in the mother during labour, while Apgar scores may decrease in the newborn and resuscitation may be needed.
In the postnatal period, breastfeeding is desirable for emotional attachment and as a healthy compensation for prenatal exposure to cancer treatment. However, the safety and feasibility of breastfeeding needs to be carefully assessed.
Psychosocial support during pregnancy, birth and postnatal periods in women with cancer strengthens the mother-infant relationship and contributes to the support of family formation.
In conclusion, pregnancy, birth and postpartum period in women with cancer is a complex process that requires a multidisciplinary approach and individualised treatment plans.
This chapter provides a detailed overview of the pathways to be followed and the points to be considered in the management of the association of cancer and pregnancy. Strategies for appropriate treatment and follow-up are emphasised to protect the health of both mother and baby.