Perinatal outcome in pregnant women with cancer: are there any effects of chemotherapy?

Cancer is the leading cause of death in women of reproductive age. During the last decades and especially in developed countries, the incidence of cancer is increasing dramatically, with an incidence of 1 in 1,000 pregnancies. This is mostly related to delay of pregnancy into the late reproductive years. The aim of this study was to investigate the outcome of pregnancy in women with diagnosis of cancer; in particular, neonatal morbidity and mortality, after in utero exposure to chemotherapy, were evaluated. A total of 59 singletons and one twin pregnancy complicated by cancer were followed at our tertiary centre over the last 15 years. A different treatment, based on surgery and/or chemotherapy in pregnancy or delayed to the postpartum period, was employed. There were 59 live births (97%), one foetal loss and one stillbirth at 28 weeks. The congenital malformation rate was 5% (n = 3). The rate of preterm birth was 83%. The mean birthweight and mean birthweight percentile were 2,098 g (740-3930) and 46 (7-93), respectively; 32% of neonates were small for gestational age (SGA). Dividing the population into treated or untreated with chemotherapy, the rate of SGA was not statistically significant different between the two groups. Our results showed that chemotherapy administered during the second trimester or later did not influence intrauterine foetal growth, but the high prevalence of SGA neonates in the two groups, exposed or not exposed to chemotherapy, suggests an influence of maternal cancer per se on foetal growth.

Demographics of breast cancer in a small cohort of women in the Caribbean

OBJECTIVES: To address the prevalence and spectrum of breast cancer (BRCA1 and BRCA2) mutations in the Caribbean population. DESIGN AND METHODS: Demographic and clinical pathologic data was collected from 347 women of Afro-Caribbean decent. The cohort included women with breast cancer from the following countries: the Cayman Islands, Jamaica, Barbados, Dominica, Trinidad & Tobago and Haiti. RESULTS: The mean age of onset in the cohort was 48.1 yrs. with a mean body mass index (BMI) of 27.7. 70% of breast cancer cases were estrogen receptor-positive (ER+) (n=241) and in Jamaica 27% (n=105) of breast cancer cases were human epidermal growth factor receptor 2 positive (Her2+). Total Abdominal Hysterectomy Bilateral Salpingo Oophorectomy (TAH-BSO) delayed invasive breast cancer from 48 to 53 years (p=0.005). Parity was a significant factor (p<0.0001), which delayed age of onset by 8 yrs. Additionally, pregnancy alone delayed age of onset (p<0.005) by 8 yrs. Only three women out of 347 were found to have a mutation. CONCLUSIONS: This population-based study provided an insight into pattern of risk factors – both genetic and environmental of breast cancer incidence and subtype across the Caribbean. In conclusion 1) genetic causes of breast cancer appeared rare outside of the Bahamas, 2) fertility factors appeared important in the development of breast cancer, 3) TAH-BSO was common as both a form of contraception and because of the high incidence of fibroids, it may be protective, 4) BMI may impact on breast cancer development and 5) screening mammography was rare and the vast majority was diagnostic in nature.

The relationship between TORCH complex false positivity and obstetric outcome in patients with antiphospholipid syndrome.

OBJECTIVE: The presence of TORCH IgM positivity is not a specific indicator of primary infection; the assessment of IgG avidity index has been shown to be useful in identifying or excluding primary infection in pregnant women with no pre-gestational TORCH serology. TORCH is an acronym for Toxoplasmosis, Others (HBV, syphilis, Varicella-Zoster virus, Epstein Barr virus, Coxsackie virus and Parvovirus), Rubella, Cytomegalovirus (CMV) and Herpes Simplex. PATIENTS AND METHODS: Data from 54 pregnancies in women with antiphospholipid syndrome (APS) were assessed in comparison with data from 222 healthy pregnant women as controls. Each woman in both groups was systematically screened for TORCH IgG and IgM during pre-conceptional evaluation and/or at the beginning of pregnancy. The assessment of IgG avidity was also evaluated in order to identify primary infection or false positivity. RESULTS: A significant increase of CMV IgM false positivity in APS in comparison with controls was detected. A worse pregnancy outcome was observed among APS patients having CMV IgM false positivity in comparison with APS patients without false positivity; in particular a statistically significant lower neonatal birth weight and a lower neonatal birth weight percentile were observed. CONCLUSION: Our data suggest that the presence of CMV IgM false positivity could represent a novel prognostic factor for poor pregnancy outcome in APS patients.

PP029. Gestational hypertension and birth weight in twin pregnancies.

INTRODUCTION: It is well known that hypertensive disorders of pregnancy are most frequent in twin pregnancies than in singleton ones. As demonstrated by a previous work of our group, twin pregnancies complicated by preeclampsia are associated with a higher rate of "small for gestational age" (SGA) neonates and inter-twin weight discordance than normotensive ones. OBJECTIVES: The present study investigates the effect of gestational hypertension (GH) on neonatal birth weight, inter-twin weight discordance and growth restriction rate among twin pregnancies. METHODS: A 26 year retrospective study was undertaken by examining 196 twin pregnancies complicated by GH, from January 1, 1980 to December 31, 2006, and comparing them to 912 normotensive twin pregnancies. RESULTS: No significant differences were observed between the two groups in relationship to birth weight, inter-twin weight discordance and growth restriction rate, with a trend towards a higher birth weight in GH group. In normotensive group, the discordance >25% was associated with a lower gestational age at the delivery (p<0.00001). Moreover, the rate of pregnancies with SGA second twin gradually rose while paralleling the degree of discordance. CONCLUSION: Contrary to preeclampsia in twin pregnancies the outcome of those complicated by GH is similar to normotensive ones. The trend towards a higher birth weight in GH seems apparently paradoxical, but it may reflect the role of uncomplicated hypertension in twin pregnancies: the increased blood pressure could be a physiologic response for more blood nutrient supply to the fetuses.

PP158. Hypertensive disorders in pregnant women affected by type I diabetes.

INTRODUCTION: Type I diabetes in pregnancy is associated with an increased incidence of hypertensive disorders. OBJECTIVES: The aim of the present study was to evaluate the incidence of hypertensive disorders in pregnant women affected by type I diabetes and pregnancy outcome in women with and without hypertension. METHODS: One hundred seventy two pregnancies in 150 women affected by type I diabetes were assessed. Twelve pregnancies were excluded (8 because of spontaneous abortions, 1 for voluntary abortion and 3 twin pregnancies), and 160 pregnancies were considered for the study. RESULTS: Twenty-five pregnancies (15.6%) were complicated by hypertensive disorders: 4.4% by chronic hypertension (CH), 5% by gestational hypertension (GH), 4.4% by preeclampsia (PE) and 1.8% by preeclampsia superimposed on chronic hypertension (PE+CH); 32% of the women presented a vascular disease (renal or retinal disease). The diabetic women with hypertensive complications were compared with diabetic women without hypertension. The main results are shown in Table 1. Significant differences in mean birth weight and mean gestational age were found. The group affected by preeclampsia showed 14.7% of small for gestational age (SGA) neonates (birth weight percentile less than 10th pc), and 57.1% of large for gestational age (LGA) neonates (birth weight percentile greater than 90th pc), two of them were over 4000 g. Only one case of very preterm delivery (<32 weeks) was observed in the sample. CONCLUSION: As expected, the incidence of hypertensive disorders in population affected by type 1 diabetes is higher than in general population and a poor pregnancy outcome was observed in this group of women. However, the neonatal outcome of women affected by preeclampsia is not different from that observed in women without hypertensive complications (diabetic controls) in terms of mean birth weight despite a significantly lower mean week gestation at delivery.

Embracing a family-centred response to the HIV/AIDS epidemic for the elimination of pediatric AIDS.

There are 2.1 million children under the age of 15 living with HIV/AIDS, and 290,000 children died of AIDS in 2007. Despite recent increases in the number of adults on antiretroviral therapy (ART), the number of children receiving treatment remains inappropriately small, and prevention of mother to child transmission (PMTCT) efforts have been grossly inadequate. In sub-Saharan Africa, 14% of those in need of treatment are children, but only 6% of those are receiving treatment. Globally, only 23% of HIV-positive pregnant women have access to PMTCT programmes, which led to 420,000 new pediatric infections last year. Countries with comprehensive, integrated family-centred care programmes are better equipped to prevent and treat pediatric HIV/AIDS. True family-centred care offers prompt maternal and pediatric HIV diagnosis, antiretroviral prophylaxis, cotrimoxazole prophylaxis, and long-term ART for the entire family, as appropriate. Simple child health interventions, prompt treatment of opportunistic infections, nutritional supplementation and infant replacement feeding, as well as malaria treatment and prevention have been proven to synergistically improve pediatric HIV care and increase service uptake. To eliminate pediatric HIV/AIDS, national governments must embrace family-centred care, implement pediatric-friendly infrastructure, and train healthcare workers to treat children.

Gastric lipomas: a rare cause of massive upper gastrointestinal bleeding.

Gastric lipomas are rare and most frequently present as upper gastrointestinal bleeding. Wide excision is advocated for small lesions and incisional biopsy followed by excision or shelling out of the tumor for large lesions. Histologic confirmation is essential so that a cancer operation, should it be necessary, will not be compromised. Concomitant lesions must be sought and treated appropriately.

Aggressive management of potential penetrating cardiac injuries.

Since 1970 all patients admitted with penetrating injuries near the cardiac silhouette are transferred immediately to the operating room for resuscitation and evaluation for immediate thoracotomy. The clinical courses of 10 patients with penetrating cardiac injuries treated between 1962 and 1969 were analyzed and compared with those of 33 patients who presented between 1970 and 1977 and were managed more aggressively. Since the institution of this more aggressive policy, overall survival has improved from 20% to 67%. In patients arriving in the emergency room with signs of viability, survival increased from 29% to 76%. Of 53 patients with injuries in the area of the cardiac silhouette, 33 (62%) actually sustained cardiac injury. The high probability of cardiac injury in patients with external wounds in the silhouette and the improved survival rate seen with aggressive surgical therapy justifies the change to this policy.

Wound infections after colectomy.

The records of 650 patients were analyzed to determine factors predisposing the patients to wound infections. Statistically significant increases in infections were found in association with Crohn's disease, stomas present preoperatively, serum albumin levels of less than 2.9 g/dl, operative blood losses greater than 1,200 ml or operative times longer than two hours, preoperative irradiation, and bowel preparations other than mechanical preparation and nonabsorbable antibiotics. Wound infection did not occur in patients who were prepared for the operation with the neomycin-erythromycin antibiotic regimen.