Management of pregnancy in the context of a cancer diagnosis (or recurrence) is jointly considered by oncologists, obstetricians and neonatologists. The recommendation to terminate or to continue the pregnancy takes into account many factors; including the pregnancy gestation, planned treatment modalities, urgency of the treatment and the prognosis of the mother. The primary focus in the decision-making phase is on the physical well-being and survival prospects of both mother and baby. Complex clinical decisions are further complicated by the interplay of emotional, ethical, moral, spiritual and cultural issues.
This paper will explore the multidisciplinary input required to optimally manage the overall care of the pregnant woman, her baby, her partner and significant others. Loss of a pregnancy at any gestation is potentially traumatic for the parents. The psychological impact of early loss may be overlooked and unacknowledged when the reason for the termination is associated with maternal survival; particularly where there is hope for future child-bearing. At the other end of the scale, late termination with foetal demise at a viable gestation is extremely fraught. Questions of ethical considerations, religious beliefs and practices, along with the practical and legal requirements of managing the consequences of a stillbirth add to the complexity of the overall management of the woman and her partner.
Skilful and expert psychosocial support is crucial to optimising the bereavement outcomes for the parents. Cancer care teams need to utilise all of their combined resources to respectfully balance maternal autonomy with the rights and status of the foetus. Most couples will need guidance and high-level information about the consequences of cancer treatments if they elect to continue the pregnancy; or conversely, about the practical and logistic consequences of termination resulting in miscarriage or stillbirth.
Underpinning the principles of best practice care for their patient, cancer care teams need to be cognisant of the sometimes dissonant personal views of individual team members and of the personal impact of highly charged emotional care planning.