Carcinoma cervix with pregnancy data taken from the DC Dutta's Textbook of OBSTETRICS by Hiralal Konar

1. Carcinoma cervix with
Pregnancy
PRESENTED BY:-
SAURABH KUMAR
B.SC. Nursing IVth year
MIHER college of nursing

2. INCIDENCES
1 in 2,500 pregnancies

3. DIAGNOSIS
 ASYMPTOMATIC CASES :- Dyskaryotic smear are subjected
to colposcopic directed biopsy.
 SYMPTOMATIC CASES :- Bleeding, APH, abortion

4. PITFALLS IN DIAGNOSIS DURING PREGNANCY
 Indurated feel of malignancy may not be evident.
 Benign lesions such as ectopy or polyp may bleed to touch.
 Extension to the parametrium may not be well defined and as
such, cases are often understaged.
Disease spread is better assessed by MRI. Cystoscopy and sigmoidoscopy
can be done. CT scanning is avoided in pregnancy.

5. EFFECTS OF PREGNANCY ON CARCINOMA CERVIX
 The malignant process remains unaffected.
 There may be a rapid spread following vaginal delivery and
induced abortion.

7. EFFECTS OF CARCINOMA ON PREGNANCY
There is increased incidence of :-
 Abortion
 Premature labor
 Secondary cervical dystocia
 Injury to the cervix and lower segment leading to traumatic
PPH
 Lochiometra and pyometra
 Uterine sepsis

8. TREATMENT
CARCINOMA IN SITU :- The pregnancy should be followed up
as usual with periodic cytologic and colposcopic evaluation.
There is no contraindication to vaginal delivery.
1. FIRST TRIMESTER :- Radical hysterectomy(with the fetus in
uterus), pelvic lymphadenectomy, and aortic node sampling
are done. Oophoropexy at the time of hysterectomy may be
done.

9. 2. SECOND TRIMESTER :- Chemotherapy, cesarean delivery,
pelvic lymphadenectomy, abdominal hysterectomy (classic
cesarean section), radical surgery.
3. THIRD TRIMESTER :- Radical hysterectomy, pelvic
lymphadenectomy after classic cesarean delivery.

10. ADVANCED INVASIVE DESEASE (STAGE III, IV) :-
1. FIRST TRIMESTER:- Chemotherapy and external beam
irradiation, spontaneous abortion (2-5 weeks) or uterine
evacuation, brachytherapy.
2. SECOND OR THIRD TRIMESTER :- Classical cesarean
delivery, neoadjuvant chemotherapy and irradiation
(external beam and brachytherapy).

11. PROGNOSIS
Stage for the survival outcome of women with cervical cancer
in pregnancy is no different when compared to the non-
pregnant women.

12. LABOR & DELIVERY
 Vaginal delivery is avoided
 Risk of vaginal bleeding is significant as the tissues are friable
 There may be cervical dystocia also
 Delivery by classical cesarean section is commonly done
 Followed by definitive therapy

13. Thank you
BE EDUCATED BE HAPPY