Hodgkin's disease during pregnancy: a case report and review of the literature

The simultaneous presence of cancer and pregnancy is rare but occurs, creating extreme scenarios in clinical practice. Hodgkin's disease (HD), affects primarily young adults and therefore obstetricians may confront young women with this type of lymphoma during pregnancy. We report a case of a 27-year-old woman with HD who presented during the 28th week of gestation. After counseling the couple decided to continue with the pregnancy. The patient received conservative treatment with regression of the symptoms and rapid improvement of her general condition. At 36 weeks of gestation a healthy infant was born and the patient underwent chemotherapy after delivery with complete resolution of the disease.     

Inflammatory bowel disease: management issues during pregnancy

Introduction Inflammatory bowel disease often affects women during their reproductive years, causing management concerns for obstetricians caring for these patients during pregnancy. Treatment Apart from methotrexate, most drugs used regularly to treat ulcerative colitis and Crohn's disease can safely be used by pregnant women. No causal relationship has been established between exposure to sulfasalazine or other 5-aminosalicylic acid drugs and the development of congenital malformations and these drugs may be used with relative safety during pregnancy and lactation. Current evidence indicates that maternal use of azathioprine and mercaptopurine is not associated with an increased risk of congenital malformations, though impaired foetal immunity, intrauterine growth retardation and prematurity are occasionally observed. Cyclosporin is not teratogenic, but may be associated with growth retardation and prematurity. Conclusions Pregnancy should be avoided in women treated with methotrexate because of its known abortifacient effects and risk of causing typical malformations. There is no actual evidence of adverse effect in pregnant women receiving Infliximab but the amount of clinical information is small. The treatment with metronidazole or ciprofloxacin for short durations appear to be safe, but there is no data about the effects of increased length of treatment as required in Crohn's disease remains unknown. Control of disease activity before conception and during pregnancy is critical to optimise both maternal and foetal health. A multidisciplined approach involving both obstetrician and gastroenterologist and education about pregnancy are essential components of the treatment of any young women with IBD.     

Fetal renal malformation following treatment of Hodgkin's disease during pregnancy.

A case of human fetal renal maldevelopment following the administration of nitrogen mustard, vincristine, procarbazine, and prednisone in early pregnancy for therapy of Hodgkin's disease is reported. While these agents have been shown to be teratogenic in animal experiments, adverse fetal effects following their use during early human pregnancy have not been described. In spite of this previous experience, it has generally been recommended that these agents be withheld during the first trimester of pregnancy because of their presumed teratogenic potential. This case would seem to reinforce this recommendation.     

Benign intracranial hypertension in pregnancy: current diagnostic and therapeutic approach

Four cases of benign intracranial hypertension (BIH) in pregnancy are presented. Literature regarding this rare entity is reviewed. Various diagnostic and therapeutic approaches in the management of BIH are described, with special emphasis on the newer neurodiagnostic and neurosurgical approaches. Guidelines have been suggested in diagnosing and managing this syndrome in pregnancy.     

Urological conditions in pregnancy: a diagnostic and therapeutic challenge.

Urological conditions in pregnancy represent a major diagnostic and therapeutic challenge. The potential adverse effects of anaesthesia, radiation and drugs on the fetus often complicate traditional diagnostic and treatment measures. As frontline clinicians, obstetricians need an awareness of symptoms, associated obstetric complications and an appreciation of available current diagnostic and therapeutic modalities and their associated risks. This article describes common urinary problems encountered in pregnancy: infection, hydronephrosis and urolithiasis specifically. The aim of this paper is to review the safety, efficacy and role of different imaging studies available for the diagnosis of urolithiasis in pregnancy. Conservative management as first line treatment and a variety of interventional urological procedures with postoperative management are also discussed. Such a background may facilitate a rational management protocol for urological problems in a pregnant woman.     

von Willebrand's disease and pregnancy: management during delivery and outcome of offspring

Six patients having different subtypes of von Willebrand's disease were followed up during eight complete pregnancies. Two additional pregnancies terminated in spontaneous abortions. Five pregnancies ended in cesarean section either because of obstetric problems (three) or electively (two) to avoid infant bleeding. Three deliveries were complicated by vaginal bleeding attributed to von Willebrand's disease, while bleeding during two deliveries had clear obstetric causes. Only two deliveries were associated with no bleeding complications. Five newborn babies were found to have von Willebrand's disease. One of them was born with a head hematoma. Management, which included cryoprecipitate and desmopressin (Stimate), is discussed. It is important to manage each case individually since obstetric parameters and severity of bleeding disorder must be known before treatment is planned.     

Precancerous cervical lesions during pregnancy: diagnostic and treatment

The rate of CIN discovered during pregnancy is around 1%. Pregnancy should be a period for the checking of pap-smear. So a pap-smear should be performed if the last one is more than two years old. If the pap-smear is less than two years old, a copy of its result should be obtained. The cervical cytology is valid during pregnancy, and usually pregnancy induced an opening of the junction zone that helps to have a good evaluation of the cervix. When atypical cells are found in the pap-smear performed during pregnancy, the management should include a colposcopy and biopsies, whatever the severity of the abnormal cells (ASC-US, ASC-H, AGC, LBG, LHG, invasive carcinoma). The biopsy should be guided by the colposcopy. Biopsy is required for an optimal diagnosis. The management of the pregnant patient should be based on the results of cytology, and colposcopy and biopsies. Currently there is no indication for HPV-typing during pregnancy. If an invasive tumor is excluded after cytology, and colposcopy and biopsy, no treatment is performed during pregnancy, and the treatment is postponed after delivery following a complete cervical reevaluation. If an invasion cannot be excluded with the biopsy; a diagnostic conization completed with a cerclage should be performed. This procedure should be exceptionally performed. During pregnancy, CIN lesions are usually stable or regress; progression of CIN is rare. When managing an abnormal pap-smear during pregnancy, a microinvasive cervical cancer may be found on a biopsy or conization specimen. Staging of these lesions requires always a conization and eventually a pelvic MRI. Microinvasive cervical cancers can be only followed until the end of the pregnancy.     

Paraganglioma in pregnancy: interdisciplinary management during pregnancy

Paragangliomas are tumors that originate from the extra-adrenal neural crest, the incidence of which during pregnancy is not more than two to eight cases per million people per year and are known to be highly morbid. The purpose of this report is to describe the experience and results obtained during management of a primigravida diagnosed with paraganglioma on week 21.2 and received both medical and surgical management with good maternal and perinatal outcomes. This case report evidences the importance of practicing interdisciplinary management of patients with clinical suspicion of paragangliomas or pheochromocytomas during pregnancy at high-complexity centers even in a medium-income country.     

Paget's disease of the vulva: diagnostic and therapeutic problems

Two cases of Paget's disease of the vulva are presented and the complex problem of diagnosis of this neoplasia is evaluated: all the diagnosis tests used in vulvar disease (vulvar citology, toluidine blue test) are insufficient in the presence of on eventual underlying carcinoma. In view of these considerations, the therapeutic approach is total vulvectomy.