Гинекология и акушерство

Гинекология и акушерство
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ISSN: 2161-0932


Place Value of Chemotherapy during Pregnancy

Dimpee Verma and Jyotsna Vermab

Approximately, 1 in 1,000-2,000 pregnancies today is complicated by cancers such as Breast, Cervical, Lymphoma or Melanoma; whose treatment is centralized to Chemotherapy via certain cytotoxic and other drugs. BUT, IS CHEMOTHERAPY DURING PREGNANCY REALLY A WISE CHOICE?

Depending upon the Impact of pregnancy on the outcome of cancer, Gestational age and risk of metastasis to the placenta and fetus, and Safety of treatment; chemotherapy is suggested which ironically, yields an increased risk of birth defects. Certain cancers like Hodgkin Lymphoma and Breast cancer can have their treatment delayed, until delivery by giving steroids and till the completion of first trimester, respectively. But Cervical and Melanoma cancers require an urgent treatment due to their high metastasis property. In cervical cancer, chemotherapy starts only after the termination of pregnancy as the Uterus itself gets affected. While in melanoma, Placenta and Fetus are the targets due to certain hormonal changes.

The greatest risk to the fetus occurs during the first trimester as it is the Critical stage of its development, especially when chemotherapy involves anti-metabolite drugs. Such cytotoxic agents interrupt metabolic pathways by destroying macromolecules of tumor as well as of normal tissue, thereby interfering with DNA and RNA synthesis. As a result, it leads to systemic toxicity and teratogenicity. These conditions cause defects like ventriculomegaly, bicuspid aortic valve, high arched palate, limb malformations, necrotizing enterocolitis in the fetus. Moreover, there is also the risk of infection and hemorrhage caused by Myelosuppression chemotherapy that causes lowering in Red Blood Corpuscles, White Blood Corpuscles and Platelet count.

Thus, in all such cancers and their therapies, the primary concern remains centralized – Exposure of fetus to the therapy and its wellbeing. There is a need to befit chemotherapy during the course of pregnancy at a place, where it acts as a boon for both the mother as well as the developing fetus.