The life expectancy of women with cystic fibrosis has doubled in the last 20 years. A major implication of this is the advent of previously unseen reproductive health problems. We review the management problems presented by these women throughout their reproductive lives, including pregnancy.
A 33-year-old woman, gravida 6, para 4+ 1, presented to antenatal clinic at 34 weeks' gestation with an apparent antepartum haemorrhage (APH), loin pain and dysuria. She appeared generally unwell and was tender over her right loin. At this visit it was noted that she had had recurrent urinary tract infections during all her pregnancies. A speculum examination did not reveal blood. Urine dipstix showed large am ount of blood and protein. Investigations for pyelonephritis and an antepartum haemorrhage of uncertain origin were performed. A mid stream sample grew (M SSU) m ixed colifor m s on culture. O bstetric ultrasound showed persistent placental lakes. Ultrasound of the renal tract revealed a small tum our in the bladder however urine cytology was negative.The urologists performed a¯exible cystoscopy, which con® r m ed the presence of a poorly differentiated transitional cell carcinoma of the bladder. At elective caesarean section at 37 weeks' gestation, the tum our was found to be 2×2 cm in the right lateral wall of the bladder, not ® xed but extending as far as the pelvic side wall.She elected to have radiotherapy rather than radical cystectomy. After the ® rst course of radiotherapy she was a dm itted w ith pne um on ia, he r co nd itio n deteriorated and she died 3 months postpartum of pneumonia secondary to metastatic bladder cancer. CommentBladder cancer in pregnancy is exceptionally rare. Low grade non-invasive tumours were reported in nine of the 14 cases (Loughlin, 1995;Danisman et al., 1997). Th ese have an excellent prognosis and are treated, without harm to the pregnancy, by transurethral resection (TU RBT) and follow-up cystoscopies.Fo r the high grade invas ive tum our s, w ith no evidence of metastatic disease, radical cystectomy at caesarean, or after term ination is probably justi® ed as the prognosis appears to be very poor, 75% mortality in the reported cases in pregnancy. A major problem in the presentation of bladder cancer during pregnancy, is haem aturia be ing m isdiagnosed as an tepartum haemorrhage of uncertain origin. Common urinary tract symptoms can also be too readily dismissed as being pregnancy-related symptoms by both patients and health care professionals. This patient by regularly attending antenatal clinics was effectively and rigorously screened for urinary tract problems and yet over several years these abnormalities were overlooked by several professionals. Even wh en ab norm alities are detected pregnancy can overshadow the logical clinical investigations. N one more so than those of the renal tract which rely on radiological investigation. A delay in the diagnosis of bladder tumours can have a severely detrim ental effect on prognosis.Any episode of haematuria, even microscopic, in the absence of infection, whether in pregnancy or not, requires an ultrasound of the renal tract and a¯exible cystoscopy. Ultrasound is a useful diagnostic tool in pregnancy, detection rates for bladder tumours greater than 2 cm are 95% (Itzchak et al., 1981). Recurrent urinary tract infections...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.