Although a rare and challenging condition, cancer during pregnancy should promptly be identified and treated. Not only standards of care guidelines for the underlying disease are taken into account, but also fetal safety might be weighted for clinical decisions. Frequent lack of experience and knowledge about this condition could lead to late diagnosis, imprecise management, suboptimal treatment and fetal and maternal harm. Therefore, this review aims to summarize the current evidence regarding the epidemiology, clinical presentation, diagnostic workup, staging and treatment, including novel treatment modalities for patients diagnosed with cancer during pregnancy.

F etal heart rate (FHR) abnormalities can occur after the initiation of labor analgesia. Although combined spinalepidural (CSE) analgesia with opioids has been associated with a higher incidence of nonreassuring FHR tracings immediately after block placement than with epidural analgesia, the possible causes have not been confirmed. One hypothesis is that the rapid onset of pain relief creates an imbalance in maternal catecholamine levels leading to uterine hyperactivity. This prospective, randomized study compared the effects of CSE and traditional epidural (EPI) analgesia on uterine basal tone and their association with FHR abnormalities.Low-risk laboring patients with singleton, cephalic, full-term pregnancies who requested analgesia before 7 cm of cervical dilatation were enrolled. Of the 91 patients who were initially enrolled, 14 were excluded, primarily for cardiotocographic failure. Forty-one patients were randomly assigned to receive CSE and 36 to EPI analgesia. All received a 10 mL/kg bolus of lactated Ringer's solution prior to an intrathecal injection of 2.5 mg of 0.5% bupivacaine with 2.5 mg sufentanil in the CSE group or 12.5 mg 0.125% bupivacaine with sufentanil 12.5 mg in the EPI group. Patients were monitored with an intrauterine pressure transducer for at least 15 minutes before and 15 minutes after labor analgesia. FHR was monitored with an external transducer and tracings were evaluated by a blinded observer. Pain was assessed with a 10-cm visual analogue scale (VAS). Primary outcomes were the occurrence of prolonged decelerations or fetal bradycardia and an increase of Z10 mm Hg in basal uterine tone after analgesia. Oxytocin use, hypotension, and speed of pain relief were also recorded. Power analysis suggested that 84 parturients would have to be randomized to have an 85% chance of detecting a 30% difference in uterine basal tone of 10 mm Hg.The groups did not differ in maternal demographic characteristics. Uterine tone was elevated in 17 (41.5%) and 6 (16.7%) patients in the CSE and EPI groups, respectively (P = 0.18) in the first 15 minutes after analgesia. FHR abnormalities were present in 13 (31.7%) of patients in the CSE group compared with 2 (5.6%) in the EPI group (P<0.01). Of the 13 women with FHR abnormalities during the first 15 minutes of analgesia in the CSE group, 7 had bradycardia and 6 had prolonged decelerations. In the EPI group, one tracing showed a prolonged deceleration and another had bradycardia. FHR abnormalities associated with hypertonus occurred in 11 (26.8%) of the CSE group and 1 (2.8%) of the EPI group (P<0.01). Two women in the CSE group had maternal hypotension compared with none in the EPI group, not a significant difference. Hypertonus and nonreassuring FHR were resolved with hydration, suspension of oxytocin if used before analgesia, and maternal supplementation with oxygen. No patient required tocolysis and no emergency cesarean delivery was performed because of fetal distress. Mean pain relief on VAS was higher in the CSE group at all evaluations up to 20 ...

OBJECTIVES:To analyze the influence of lying in prone position on a specially designed stretcher on the maternal-fetal hemodynamic parameters and comfort of pregnant women.METHODS:A randomized, controlled trial with 33 pregnant women divided into 2 groups: pregnant group sequence 1 and pregnant group sequence 2. The order of positions used in sequence 1 was Fowler’s position, prone position, supine position, left lateral, Fowler’s position 2, supine position 2, prone position 2 and left lateral 2. The order of positions used in sequence 2 was Fowler’s position, prone position, left lateral, supine position, Fowler’s position 2, left lateral 2, prone position 2 and supine position 2. Each woman remained in each position for 6 minutes. For the statistical analyses, we used Wilcoxon’s test for 2 paired samples when comparing the prone position with the other positions. The variables are presented in graphs showing the means and 95% confidence intervals. Trial Registration: Clinical Trial No. ISRCTN41359519RESULTS:All the parameters were within the standards of normality. There were no differences between positions in terms of maternal heart rate, diastolic blood pressure, oxygen saturation and fetal heart rate. However, there were significant decreases in respiratory rate and systolic blood pressure in prone position 2 compared with left lateral 2. There was an increase in oxygen saturation in prone position compared with Fowler’s position and supine position 2 in both sequences. All the women reported feeling comfortable in the prone position.CONCLUSIONS:The prone position was considered safe and comfortable and could be advantageous for improving oxygen saturation and reducing the systolic blood pressure and respiratory rate.

Background: Breaking bad news is a frequent task in high-risk obstetrics clinics. Few studies have examined the role of training in improving such a difficult medical task. Aim: To evaluate the influence of a training program on the participants' perceptions of bad news communication at a high-risk obstetrics center. Design: This prospective study was conducted at the Department of Obstetrics/Gynecology, Hospital das Clinicas, from March 2016 to May 2017. Setting/Participants: Maternal-fetal health specialists were invited to complete an institutional questionnaire based on the SPIKES protocol for communicating bad news before and after training. The training consisted of theoretical lectures and small group practice using role play. The questionnaire responses were compared using nonparametric tests to evaluate the differences in physicians' perceptions at the two timepoints. The questionnaire items were evaluated individually and in groups following the communication steps of the SPIKES protocol. Results: In total, 110 physicians were invited to participate. Ninety completed the pretraining questionnaire and 40 answered the post-training questionnaire. After training, there were significant improvements in knowing how to prepare the environment before delivering bad news (p = 0.010), feeling able to transmit bad news (p < 0.001), and to discuss the prognosis (p = 0.026), feeling capable of discussing ending the pregnancy (p = 0.003), and end-of-life issues (p = 0.007) and feeling confident about answering difficult questions (p = 0.004). The comparison of the grouped responses following the steps of the SPIKES protocol showed significant differences for ''knowledge'' (p < 0.001), ''emotions,'' (p = 0.004) and ''strategy and summary'' (p = 0.002). Conclusion: The implementation of institutional training in breaking bad news changed the perception of the physicians in the communication setting.

Background : The COVID-19 pandemic gave rise to concerns about its potential impact on the mental health of pregnant and postpartum women as the general postpartum depression rates increased. Methods : Three postpartum questionnaires (Edinburgh Postnatal Depression Scale – EPDS; Anxiety and Depression Scale – HAD; and a demographic questionnaire about isolation and information acquisition) were used to evaluate the mental health of women with and without COVID-19 and determine the factors associated with depressive symptoms (EPDS ≥ 12). Results : Data from 184 participants with a mean of 56 postpartum days were analyzed. The rate of symptoms compatible with postpartum depression (PPD) was 38.8%, with a 14.3% positive response to item 10 on the EPDS (suicidal ideation - SI). Listening to the news about COVID-19 averaged 4.45 hours a day. Factors related to PPD were concerns about lack of hospital beds (OR = 2.45), absence of a partner (OR = 2.70), and anxiety symptoms (OR = 10). Factors related to SI were anxiety symptoms (OR = 1.56) and friends as a source of information (OR = 5.60). Limitations : Considering the rapidly changing epidemiological conditions of this pandemic, this study may only be the photograph of an instant. Conclusions : Higher rates of PPD in the Brazilian population are related not only to anxiety but also to an inadequate family environment, kind of information acquisition and concerns about the lack of hospital beds.