CANCER AND PREGNANCY
With a vaccine against Human Papilloma Virus (HPV
MALIGNANCIES MOST COMMONLY SEEN IN
PREGNANCY:
1. Ovarian Cancer
2. Uterine Cancer
3. Cervical Cancer
4. Breast Cancer
5. Thyroid Cancer
6. Leukemia
7. Melanoma
8. Hodgkin’s Lymphoma
DIFFICULT DECISIONS/ CHOICES FOR PATIENT AND HER
PARTNER AND THE FAMILY TO MAKE UPON
DISCOVERY OF CANCER DURING THE FIRST TRIMESTER
OF PREGNANCY:
1. To delay treatment to avoid teratogenic effects or
risks to the fetus due to the treatments.
2. To end the pregnancy to allow chemotherapy or
radiation treatments to be initiated.
3. To choose chemotherapy or radiation treatment with
the knowledge they can cause birth anomalies in the
fetus.
KEY POINTS IN CANCER IN PREGNANCY:
1. As a rule, a woman can receive chemotherapy in the
second and third trimester of pregnancy without
adverse fetal effects.
2. In contrast, radiation therapy puts the fetus at risk
throughout the pregnancy if the fetus is directly
exposed.
3. A biopsy to confirm the diagnosis or surgery to
remove the tumor can be completed during pregnancy
with the understanding that the fetus is at risk for
anoxia if a general anesthesia is used.
4.
Vaccine) available at present, cervical cancer should be
seen much less in the future.
5. Following surgery, the woman is at risk of developing
thrombus formation because of increased coagulation
process in pregnancy.
6. Cancer in a woman does not appear to metastasize to
the fetus because of the placental barrier, except in the
case of Melanoma as this seems to be capable of
spreading to the fetus.
KEY POINTS TO REMEMBER:
1. History taking with documentation is important on
the first prenatal visit in order to establish a baseline.
2. Teaching is an important nursing intervention. Health
teaching and how it affects women’s overall health
helps in planning nursing care.
3. Blood volume increases by as much as 50% during
pregnancy.
4. Iron- deficiency Anemia, Folic acid deficiency Anemia
as well as SICKLE CELL ANEMIA can cause complications
and can result in fetal distress because of inadequate
oxygen.
MORPHINE SULFATE MAY BE GIVEN FOR SEVERE PAIN
IN SICKLE CELL CRISIS. OVER DOSAGE OF MORPHINE
CAN RESULT IN RESPIRATORY DEPRESSION.
ANTIDOTE FOR MORPHINE OVER DOSAGE OR TOXICITY
IS NALOXONE.
5. Urinary Tract Infection (UTI) can cause complications
because it increases the workload of the kidneys. UTI’s
and CHRONIC RENAL DISEASE can cause EARLY
PREGNANCY LOSS.
6. Juvenile Rheumatoid Arthritis and SYSTEMIC LUPUS
ERYTHEMATOSUS (SLE) require large doses of
NON STEROID ANTI INFLAMMATORY DRUGS (NSAID’S).
SALICYLATES can cause MATERNAL BLEEDING,
BLEEDING DISORDERS IN THE NEWBORN, AND
PREMATURE CLOSURE OF DUCTUS ARTERIOSUS.
7. Asthma, pneumonia and TUBERCULOSIS are
common respiratory orders in pregnancy and good
assessment and care are needed.
Calcifications in old tuberculous lesions in the lungs can
breakdown in order to meet the growing demand for
calcium necessary for the bone development of the
fetus in mothers who have deficient calcium in their
system.
8. GESTATIONAL DIABETES AND GESTATIONAL
HYPERTENSION OCCUR ONLY DURING PREGNANCY,
AND RESOLVE AFTER DELIVERY.
PRETERN LABOR:
IT IS LABOR THAT OCCURS BEFORE THE 37 WEEKS OF
PREGNANCY. Maintaining general health during
pregnancy is the best preventive measure to avoid
preterm birth.
MEDICAL ATTEMPTS TO STOP PREMATURE LABOR ARE
EFFECTIVE:
DRUGS FOR PREMATURE LABOR:
1. BETAMETHASONE (Celestone): It is a
corticosteroid, acts as inflammatory and
immunosuppressive agent, it is given 12 to 24 hours
before birth if the fetus is less than 34 weeks to hasten
fetal lung maturity and helps prevent RESPIRATORY
DISTRESS SYNDROME (RDS) in the newborn.
2. TERBUTALINE: It is a drug approved to prevent and
treat bronchospasm (narrowing of the airways) but may
be used OFF- LABEL as a TOCOLYTIC AGENT (to halt
contractions and labor).
SPECIAL CONSIDERATIONS/ ALERT ON TERBUTALINE:
Terbutaline carries a “BLACK BOX” warning that it
should not be used for 46 to 72 hours of therapy
because of the potential for serious maternal heart
problems and death. It should NOT be used in an
outpatient or home setting as it requires strict
monitoring.

1. IF FETAL MEMBRANES HAVE NOT RUPTURED

2. IF FETAL DISTRESS IS ABSENT

3. THERE IS NO EVIDENCE THAT BLEEDING IS OCCURING

4. IF THE CERVIX IS NOT DILATED MORE THAN 4 TO 5

CMS.

5. IF CERVICAL EFFACEMENT IS NOT MORE THAN 50%.

THERAPEUTIC MANAGEMENT OF PREMATURE LABOR:

1. Admission to hospital, bed rest to relieve the

pressure of the fetus on the cervix.

2. Attach to external fetal and uterine contraction

monitors for Fetal Heart Rates (FHR), intensity of
contractions, use of Cardiotocography (CTG) machine.

3. IV Fluid therapy to keep patient well hydrated.

4. Vaginal and cervical cultures and clean catch urine

samples collected and tested (urinalysis, and urine
culture and sensitivity).

5. If UTI is present, antibiotics may be prescribed, one

that is effective for Group B Streptococcus as this
infection can be fatal in the newborn.