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Management of Pregnancy: some recommedations to be included #pregnancy

Cancer can be successfully treated during pregnancy in collaboration with a multidisciplinary team, optimizing maternal treatment while considering foetal safety. (Amant at al, Guidelines of a Second International Consensus Meeting; 2014).

To maximize the maternal outcome, cancer treatment should follow a standard treatment protocol as for non-pregnant patients. Iatrogenic prematurity should be avoided. Diagnostic procedures, including staging examinations and imaging, such as magnetic resonance imaging and sonography, are preferable. Pelvic surgery, either open or laparoscopic, as part of a treatment protocol, may reveal beneficial outcomes and is preferably performed by experts. Most standard regimens of chemotherapy can be administered

3.2 Appointments for chemotherapy administration could be combined, when possible, with obstetrical and midwifery follow up to let women feel they are taking care of pregnancy and cancer at the same level.

Additional scans or foetal heart monitoring around oncological appointments can help the women refocus on her pregnancy and improve her psychological wellbeing. It also hands an element of control back to her and her family.

3.3 Encourage and protect maternal-foetal/neonatal bonding.

Be aware that the impact of a cancer diagnosis and treatment on bonding/attachment for both mothers and their partners can be profound.

Health care professionals should be aware of the possibility that the attention on the disease process might override bonding with the baby. Side-effects of the treatment such as nausea, tiredness but also stress and anxiety about their own health might impede the mother-baby bonding.

3.4 Give these women the opportunity to receive an unscheduled ultrasound (for the general population) at the end of their oncological cycle to reassure them about the health of the foetus.

Sonographies, palpation, 3D ultrasound and the techniques of guided imagery may be used to facilitate the mother-foetus bonding and the maternal representations of the unborn-child

3.5 Offer a 1-to-1 or group preparation course.

In the group the woman will be involved in advance in decisions about type of delivery, type of breastfeeding, knowledge of milk banks and donor milk. If these are taken for, rather than with her, it can be diffcult to retract and therefore repect her wishes.

Moreover, there is no doubt about the strategic importance of such groups in offering moments of normality. Being around other mothers helps a woman with a neoplasm feel closer to problems that are more common (Prosperi at al., 2020).

3.6 Support women’s autonomy and choices to facilitate a positive birthing experience (ICI -2021).

Where it can be agreed that it will not create adverse risk for a woman, teams should do whatever possible to facilitate that woman’s preferred mode of birth unless there are medical contraindications.

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All women, including those with complications, should receive full, accurate and unbiased information based on best evidence on potential harms and benefits of obstetric and neonatal procedures and alternatives, so that they can make informed decisions about their care and their babies’ care. Access to evidence-based prenatal education to prepare women and their partners strongly contributes to this decision-making ability.

3.7 It is important to prepare and anticipate the post-partum period.

Women who will undergo adjuvant treatments and they will have not much time and not enough energy to spend with their new-born. Prepare the woman by involving her early in breastfeeding decisions. We believe in a woman’s right to be involved in the choice process. Perinatal planning will also help ensure that support is available should the mother experience Post Natal Depression (PND) or other mental health issues, which are common when the pregnancy/post-natal period has this kind of trauma.

3.8 Offer the possibility of carrying out chemotherapy in a neutral location suited to the patient’s profile in the oncological unit.

In project interviews with women, they reported their difficulties to undertake chemo among a population with different age, priorities, and worries.

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