01-30-2024

• Cancer occurs in about 1 in 1000 pregnancies
• Malignancies most commonly seen with pregnancy are those that occur most frequently in women during childbearing years
• Pregnancy itself does not cause cancer, and pregnant women do not have an increased risk of developing cancer compared to women who are not pregnant
• Most common cancers diagnosed during pregnancy:

  • Breast (most common)
  • Cervical
  • Hodgkin lymphoma (originates from lymphocytes)
  • Non-Hodgkin lymphoma (cancer of lymphatic system)
  • Ovarian
  • Malignant melanoma (skin cancer)
  • Leukemia
  • Thyroid
  • Colorectal
  • All these cancers are soft tissues and fast-growing
  • Bone cancer is the most painful cancer
• Management:

  • Client will undergo diagnostic tests for cancer
  • For example, a Pap test done during pregnancy can find cervical cancer
  • An ultrasound during pregnancy may find ovarian cancer at an early stage
• Nursing considerations for undergoing diagnostic tests for pregnant client:

  • Level of radiation in an x-ray used to diagnose cancer is too low to harm the fetus
  • CT scans use higher radiation and are more accurate at showing internal organs
  • CT scan of the abdomen or pelvis should only be done if absolutely necessary
  • Lead apron is used to cover the mother's abdomen during x-rays and CT scans
  • MRIs and ultrasounds are safe during pregnancy as they do not use radiation
  • Physical exams and many biopsies are safe tools to diagnose cancer
• If cancer is diagnosed in the first trimester, difficult decisions may include:

  • Delaying treatment to avoid teratogenic risks to the fetus
  • Ending the pregnancy to allow chemotherapy or radiation treatment
  • Choosing treatment with the knowledge of potential birth anomalies
  • Chemotherapy is systemic and targets the entire affected system
  • Best food for a patient with cancer is oats
• Cancer treatments during pregnancy may include surgery, chemotherapy, and sometimes radiation therapy, used after careful thought and planning for safety of both mother and baby
• Factors determining cancer treatment and timing:

  • Location, type, and stage of cancer
  • Age of the fetus
  • Wishes of the mother
• Chemotherapy:

  • Use of anticancer drugs to treat cancer
  • Systemic therapy that destroys cancer cells throughout the body
  • Can cause birth defects, low birth weights, or miscarriage in the first trimester
  • Toxic and have the potential to harm a fetus
  • Can be received in the second and third trimesters without adverse fetal effects
  • Can cause infection, anemia, nausea, and vomiting indirectly harming the fetus
• Radiation therapy:

  • Uses high energy x-rays or particles to destroy cancer cells
  • Puts the fetus at risk if directly exposed, causing malformations, mental retardation, and growth abnormalities
  • Lead apron or shields used to reduce fetal radiation exposure
  • Guidelines for safe radiation exposure during pregnancy
• Surgery:

  • Poses the least risk to the fetus and may be considered the safest cancer treatment option, especially after the first trimester
• Nursing considerations in surgical treatment:

  • Fetus at risk for anoxia if general anesthesia is used
  • Woman at risk for thrombus formation post-surgery due to increased coagulation in pregnancy
• Hypercoagulation:

  • Increase in thrombin and fibrinogen in preparation for blood loss in pregnancy
• Anemia is a reduction in either the number of RBC, the amount of hemoglobin, or the hematocrit
• Anemia is not a disease but a clinical indicator, occurring with many health problems
• Anemia may be physiologic or pathologic
• Physiologic anemia involves an increase in plasma, causing the RBC to be melted by the increased plasma
• Pathologic anemia may be due to iron-deficiency from menstruation or baby's demand, folic acid deficiency, or RBC not meeting the lifespan of 120 days
• Erythropoietin is released from the bone marrow to create RBC, with an increase during pregnancy by 50%
• Symptoms of anemia include excessive fatigue, headache, tachycardia, brittle fingernails, cheilosis, and smooth, red, shiny tongue
• In anemia, the oxygen-carrying capacity of hemoglobin is reduced, causing tissue hypoxia
• Tissue hypoxia can lead to fatigue, weakness, dyspnea, chest pain, angina, headache, faintness, and dim vision
• Types of anemia include iron-deficiency anemia and folic acid deficiency anemia
• Iron is a component of heme and a deficiency leads to decreased hemoglobin synthesis
• Folic acid deficiency is common in multiple gestations and can lead to neural tube defects and other birth defects
• Pseudoanemia occurs in early pregnancy due to blood volume expansion, resulting in decreased hemoglobin and hematocrit count
• Normal hemoglobin level is 12-16g/dl and normal hematocrit count is 37%-47%
• True anemia in pregnancy occurs when hemoglobin is less than 11g/dl and hematocrit is less than 33%
• The increase in blood volume during pregnancy requires additional iron, with iron needs during pregnancy being 800 micrograms daily
• Maternal and fetal risks/complications of anemia include delayed wound healing, postpartum infection, postpartum hemorrhage, maternal death if hemoglobin drops below 6g, pica, low birth weight, preterm birth, early miscarriage, and premature separation of the placenta
• Ectopic pregnancy occurs when implantation happens outside the uterine cavity, commonly in the fallopian tubes, ovary, or abdominal cavity
• Approximately 2% of pregnancies are ectopic, making it the second most frequent cause of bleeding early in pregnancy
• The incidence of ectopic pregnancy is increasing due to the rising rate of pelvic inflammatory disease, leading to tubal scarring
• Common sites for ectopic pregnancy include the fallopian tube (95% of pregnancies), ovary (0.5%), abdominal cavity (1.5%), and cervix (0.3%)
• Risk factors for ectopic pregnancy include previous STIs, pelvic inflammatory disease, salpingitis, IVF, previous tubal surgery, uterine tumor, smoking, and a history of ectopic pregnancy
• Maternal and fetal risks/complications of ectopic pregnancy include hypovolemic shock, infertility, another ectopic pregnancy, fetal deformity/growth restriction/loss, and placental implantation leading to bowel perforation and peritonitis
• Symptoms of ectopic pregnancy include missed menstrual period, adnexal fullness, tenderness, sharp stabbing pain, referred shoulder pain, Cullen's Sign, scant vaginal spotting, and signs of hypovolemic shock
• Diagnostic tests for ectopic pregnancy include ultrasound/MRI and laparoscopy/culdoscopy to confirm the location and status of the pregnancy
• Methotrexate is administered to dissolve residual tissues from ruptured ectopic pregnancy, with precautions to avoid sun exposure, alcohol, and folic acid supplements