Most of the symptoms can be managed medically in pregnant women. Surgical management is usually avoided during pregnancy. There are very few studies and no randomized trials available on the safety of myomectomy in pregnancy.14,15,16 Myomectomy during pregnancy is best avoided in all but the most extreme circumstances, such as torsion of a pedunculated myoma or when a malignancy is suspected. The 2013 Committee Opinion by the American College of Obstetricians and Gynecologists recommends that women with previous myomectomy which caused significant compromise of the uterine integrity undergo cesarean delivery rather than a trial of labor and vaginal delivery due to small but catastrophic risk of uterine rupture.17
Table 42.1 Estimates of Cancers Occurring in Pregnancy
the insufflation pressure during surgery, avoidance of touching the uterus within the peritoneal cavity, and avoidance of routine use of tocolytics.59
chemotherapy and the teratogenic effects of these agents on the developing fetus.69,70 However, as anecdotal and small series reports have accumulated, it appears that, although certain drugs must be avoided during early pregnancy, others might be life-saving and might not cause congenital anomalies in the fetus71,72,73,74 (Table 42.2).
Table 42.2 Chemotherapeutic Agents and Reported Associated Anomalies by Trimester
system for cervical cancer is seen in Table 42.3. Invasive cervical cancer is on the decline in the United States. Effective Pap smear screening techniques in combination with colposcopy for directed biopsies have allowed physicians to recognize the presence of malignancy early and to treat patients with simple office procedures. Although the decline in invasive cancer is evident in the United States, an increase in cervical intraepithelial neoplasia (CIN) has occurred as a result of widescale cytologic screening.88,89 Epidemiologic studies suggest that women who develop CIN and invasive cancer in pregnancy tend to be married at an earlier age, have an earlier age of diagnosis of CIN and invasive
cancer, and have a higher parity than a control population.90,91,92 The most common histologic types of cancer occurring in the cervix are squamous cell. Four case reports of a small cell neuroendocrine carcinoma arising in the uterine cervix in pregnancy have also been reported.93,94
Table 42.3 International Federation of Gynecology and Obstetrics (FIGO) Staging of Cancer of the Cervix Uteri (2018)