Document Detail


The therapeutic management of a twin pregnancy complicated by the presence of cervical cancer, following laparoscopic staging and chemotherapy, with an emphasis on cisplatin concentrations in the fetomaternal compartments amnion fluid, umbilical cord, and maternal serum.
MedLine Citation:
PMID:  19765705     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To evaluate the feasibility, toxicity, and pharmacokinetics in the maternal and fetal compartments during chemotherapy in a pregnant patient with cervical cancer. DESIGN: Case report. SETTING: University Hospital. PATIENT: A 35-year-old woman was diagnosed with an adenocarcinoma FIGO stage IB1 of the cervix uteri at 14 weeks' gestation with twin pregnancy. INTERVENTION(S): A laparoscopic transperitoneal pelvic lymphadenectomy was performed at 15 weeks' gestation There was no evidence of lymph node metastases (0/19). The patient decided to continue her pregnancy. Three cycles of neoadjuvant chemotherapy consisting of cisplatin during the second and third trimester were given and well tolerated. Amniocentesis was performed at the time of the second cisplatin cycle. MAIN OUTCOME MEASURE(S) AND RESULT(S): The concentration in the amniotic fluid samples reached 10% of the maternal blood levels at this time. At 32 weeks' gestation, a Caesarean section followed by radical hysterectomy was performed. The twins developed normally and displayed no chemotherapically related side effects. At the time of delivery, the corresponding concentration in the amniotic fluid was approximately one-third of the umbilical cord levels. CONCLUSION(S): To our knowledge, this is the first report quantifying the amount of transplacental transport of cisplatin during pregnancy in vivo. One-tenth of the maternal serum concentration was detected in the amniotic fluid; the concentration of cisplatin in the umbilical cord was three times higher than in the amniotic fluid.
Authors:
Simone Marnitz; Alexander Schmittel; Juliane Bolbrinker; Frank-Peter Schmidt; Guus Fons; Karim Kalache; Achim Schneider; Christhardt Köhler
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Publication Detail:
Type:  Case Reports; Evaluation Studies; Journal Article     Date:  2009-09-18
Journal Detail:
Title:  Fertility and sterility     Volume:  92     ISSN:  1556-5653     ISO Abbreviation:  Fertil. Steril.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-02     Completed Date:  2009-11-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372772     Medline TA:  Fertil Steril     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1748.e1-4     Citation Subset:  IM    
Affiliation:
Charité University Hospital, Department of Radiooncology, Berlin, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adenocarcinoma / drug therapy*,  metabolism,  pathology*
Adult
Amniotic Fluid / chemistry,  metabolism
Antineoplastic Agents / therapeutic use
Cisplatin / analysis,  blood,  pharmacokinetics,  therapeutic use*
Feasibility Studies
Female
Fetal Blood / chemistry,  metabolism
Humans
Laparoscopy
Maternal-Fetal Exchange / drug effects
Mothers
Neoplasm Staging / methods
Osmolar Concentration
Pregnancy
Pregnancy Complications, Neoplastic / drug therapy,  pathology
Pregnancy, Multiple* / drug effects
Twins
Uterine Cervical Neoplasms / drug therapy*,  metabolism,  pathology*
Chemical
Reg. No./Substance:
0/Antineoplastic Agents; 15663-27-1/Cisplatin

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