We aimed to provide comprehensive protocols and promote effective management of pregnant women with gynecological cancers. New insights and more experience have been gained since the previous ...guidelines were published in 2014. Members of the International Network on Cancer, Infertility and Pregnancy (INCIP), in collaboration with other international experts, reviewed existing literature on their respective areas of expertise. Summaries were subsequently merged into a manuscript that served as a basis for discussion during the consensus meeting. Treatment of gynecological cancers during pregnancy is attainable if management is achieved by collaboration of a multidisciplinary team of health care providers. This allows further optimization of maternal treatment, while considering fetal development and providing psychological support and long-term follow-up of the infants. Nonionizing imaging procedures are preferred diagnostic procedures, but limited ionizing imaging methods can be allowed if indispensable for treatment plans. In contrast to other cancers, standard surgery for gynecological cancers often needs to be adapted according to cancer type and gestational age. Most standard regimens of chemotherapy can be administered after 14 weeks gestational age but are not recommended beyond 35 weeks. C-section is recommended for most cervical and vulvar cancers, whereas vaginal delivery is allowed in most ovarian cancers. Breast-feeding should be avoided with ongoing chemotherapeutic, endocrine or targeted treatment. More studies that focus on the long-term toxic effects of gynecologic cancer treatments are needed to provide a full understanding of their fetal impact. In particular, data on targeted therapies that are becoming standard of care in certain gynecological malignancies is still limited. Furthermore, more studies aimed at the definition of the exact prognosis of patients after antenatal cancer treatment are warranted. Participation in existing registries (www.cancerinpregnancy.org) and the creation of national tumor boards with multidisciplinary teams of care providers (supplementary Box S1, available at Annals of Oncology online) is encouraged.
Objective
To evaluate whether a history of spontaneous early‐term birth (37+0–38+6 weeks of gestation) in the previous singleton pregnancy is a risk factor for preterm birth (PTB) in a subsequent ...twin pregnancy.
Design
Retrospective cohort study.
Settings
Two French university hospitals (2006–2016).
Population
All women who delivered twins from 24+0 weeks after a preceding singleton pregnancy birth at 37+0 to 41+6 weeks.
Methods
Multivariate logistic regression analysis of association between twin PTB and a previous spontaneous singleton early‐term birth.
Main outcome measures
Twin PTB rate before 37, 34 and 32 weeks of gestation.
Results
Among 618 twin pregnancies, 270 were born preterm, 92 of them with a preceding spontaneous singleton early‐term birth. The univariate analysis showed a significantly higher risk of twin PTB before 37, 34 and 32 weeks among those 92 women compared with those with a full‐ or late‐term birth in their previous singleton pregnancy. This association remained significant after logistic regression (odds ratio OR between 2.42 and 3.88). The secondary analysis, restricted to the twin pregnancies with spontaneous PTB found similar results, with a risk of PTB before 37, 34 and 32 weeks significantly higher among women with a previous spontaneous singleton early‐term birth, including after logistic regression analysis (OR between 3.51 and 3.56).
Conclusion
A preceding spontaneous singleton early‐term birth is a strong and easily identified risk factor for PTB in twin pregnancies.
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Spontaneous ‘early‐term’ birth of a singleton is a significant risk factor for future preterm births in twin pregnancies.
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Spontaneous ‘early‐term’ birth of a singleton is a significant risk factor for future preterm births in twin pregnancies.
The management of breast cancer during pregnancy (PrBC) is a relatively rare indication and an area where no or little evidence is available since randomized controlled trials cannot be conducted. In ...general, advances related to breast cancer (BC) treatment outside pregnancy cannot always be translated to PrBC, because both the interests of the mother and of the unborn should be considered. Evidence remains limited and/or conflicting in some specific areas where the optimal approach remains controversial. In 2022, the European Society for Medical Oncology (ESMO) held a virtual consensus-building process on this topic to gain insights from a multidisciplinary group of experts and develop statements on controversial topics that cannot be adequately addressed in the current evidence-based ESMO Clinical Practice Guideline. The aim of this consensus-building process was to discuss controversial issues relating to the management of patients with PrBC. The virtual meeting included a multidisciplinary panel of 24 leading experts from 13 countries and was chaired by S. Loibl and F. Amant. All experts were allocated to one of four different working groups. Each working group covered a specific subject area with two chairs appointed:1.PrBC: incidence, epidemiology, biology and pathology, diagnostic work-up, staging and risk assessment, prognosis (Chairs: Vincent Vandecaveye, Fedro Peccatori).2.Clinical pharmacology of systemic agents during pregnancy: management of localized disease and (neo) adjuvant therapies, management of systemic disease (Chairs: Giuseppe Curigliano, Peter Schmid).3.Obstetric care and fetal/newborn follow-up and outcomes: metastases to fetus, management of pregnancy during anticancer therapy, lactation, psychological support (Chairs: Elyce Cardonick, Mathilde van Gerwen).
Planning, preparation and execution of the consensus process was conducted according to the ESMO standard operating procedures.
•This consensus statement updates recommendations on PrBC to adequately address current based ESMO Clinical Practice Guideline.•The overall lack of high-level evidence around this topic underscores the expert opinion level of the statements.•Therefore, it is even more important to include the patients and their partners’ preference in the clinical decision making.•The recommendations include critical updates and reflections on recently emerged date published in the medical literature.
The Fetal Blood Sample (FBS) is used as an indicator of fetal acidosis during labor. Its place is discussed through the lack of randomized trials, as well as the limitations related to the technical ...procedure. An alternative could be the Fetal Scalp Stimulation (FSS).
Our objective was to describe the FSS diagnostic value to predict fetal wellbeing defined from FBS.
The FSS consisted in a digital scalp stimulation for 15 s. Test was negative when an acceleration and/or a normal variability were elicited in the 2 min following. FSS was performed before each FBS which was classified as normal when pH was > 7.25. The diagnostic value was assessed by sensibility, specificity, positive and negative predictive values.
148 women were included in our center from February to December 2019. Of the 191 FBS procedures, when accelerations were elicited sensibility was 58,3 (36.8–77.1), specificity was 67,5 (59.3–75), positive predictive value was 20,9 (12.5–32.9) and negative predictive value was 91.7 % (95 %CI, 85–95.5).
FBS is considered as the gold standard in our study which could be discussed as it is abandoned in some countries because of its questioned reliability and the lack of controlled randomized trials.
This study suggests that FSS could be an interesting alternative adjunctive test to perform in the first instance as it seems to be reliable, non-invasive and easy to perform in order to limit FBS only to absence of acceleration after FSS.
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