| The incidence of malignant tumors increase has a great increase in the past thirty years.At present,it has become the one of the leading cause of death of reproductive women in the world.Before several decades,malignant tumor has become an important healthy problem in public of China.According to the recent health report in China,it has become the second reason leading to thedeath of Chinese women,as well as a major cause of death among the women in the child-bearing age in China.The reporte to the incidence of gestational malignant mixed,about 1/ 1000～1/6000 pregnancies.The majority of malignant tumors in pregnancy are well on the hair of malignant tumors of fertility age,such as:breast cancer,cervical cancer, Hodgkin's disease,malignant melanoma and leukemia.With the change of economic development and the traditional concept,the incidence of malignant tumors increase trends to young people.The Chinese women of marriage age and fertility age become more sophisticated,especially in southern China.Therefore,it can be speculated that malignant tumors will become an important complication of pregnancy in the coming decades.The change of great physiological in pregnancy with malignant may have some impacts:pregnancy specific physiological changes in the tumor may be will cover up the condition of the tumor caused by misdiagnosis and delayed treatment of Cancer;pregnancy with the promotion of certain malignant tumors the occurrence and development of its role;pregnancy pelvic-rich blood flow and lymphatic drainage for malignant cell growth has created favorable conditions,but results have not yet confirmed pregnancy you will accelerate the growth of tumor cells,plant and disseminated.Malignant tumor to pregnancy also has important implications:Cancer of the direct effects on pregnancy;tumor with some clinical symptoms effects on diet, increased consumption of the tumor and increased mental stress of pregnant women after they found tumor and so pregnant women may result in malnutrition,thus effecting the the development of the fetus in uterus,severe induced abortion, premature delivery,fetal growth restriction,low birth weight infants,low birth weight infants the incidence of increase in perinatal mortality rates;the surgical treatment of tumor-induced abortion,premature;pregnancy period of chemotherapy can cause fetal malformations,intrauterine growth retardation and abortion;induced by radiation therapy may have future children and adult leukemia and tumors.Although the treatment of malignant tumors in pregnancy in the past decade has been a gradual accumulation,which has not yet been an exact treatment plan,there are still a lot of problems about it during pregnancy,such as,whether it is necessary to terminate pregnancy;pregnancy will speed up the progress of the tumor or not; extension of the treatment will affect on the prognosis of the mother and so on.About ovarian malignancy in pregnancy complications,whether or not to continue pregnancy,delivery mode and select the prognosis of such patients,all of these has become hot points of research.At home and abroad about the treatment of malignant tumors in pregnancy has reported in cases,lack of large sample surveys. PurposeIn the view of the doubt and uncertainty on the pregnancy merger malignant tumors.Through the analysis of the clinical data of patients with malignant tumor pregnancy merger,which is based on three major teaching hospitals from Guangzhou and Shenzhen nearly 16 years,we analyze its characteristics,processing,and results.In the meanwhile,we analyze the mutual influence that may happen between disease and pregnancy.According to the analysis of the original data,we hope to find out the exact and important information to afford the clinical evidence for the treatment plan of the pregnancy merger malignant tumors.Ways1,Data collectionThe use of retrospective data analysis methodsm for the collection of the South Great Southern medical hospital,the First People's Hospital of Shenzhen,Shenzhen Hospital of Beijing University,three three-level hospital in January 1992 to December 2008 treated at the pregnancy was diagnosed as combined the 34 cases of malignant tumor cases.Pregnancy before the treatment or be excluded from the end of treatment,rather than malignant diagnosis at this stage and carcinoma in situ were excluded.At the same time in the same period 100 cases of randomly selected hospital delivery is not at the normal maternal complications of pregnancy as a control group.History information including age,pregnancy history,gestational age at the time of symptoms,gestational age at diagnosis,the pathological type of tumor stage,treatment during pregnancy,childbirth methods,the incidence of postpartum hemorrhage,the occurrence of puerperal morbidity,neonatal weight,birth score, post-treatment cases,such as through retrospective surveys,the follow-up of patients and offspring,or through telephone follow-up questionnaire to obtain.2,Diagnostic criteriaObstetrician confirm pantient gestation and embryo age with diagnoses of the last menstruate,physical examination and ultrasonic check.And the course of the whole gestation was in custody of veteran obstetrician.All malignancy are diagnosed by diplomate who according to International Union Against Cancer,and pathologic diagnoses were given by two veteran obstetrician.Obstetrician and paediatrician give the diagnoses of embryo and baby.3,The method(1) Through collect and analyse the cases of pregnant patient with malignancy, to know the incidence and the malignancy type of this peculiar disease.(2) We make the malignant tumor tumor as a integer in this study for find the correlativity between malignant tumor and gestation.According to whether terminate gestation,the patients were divided into two groups:termination group and continue group.And we analysed the time and livability from beginning symptom to malignant tumor for both two groups.(3) 100 normal pregnancy women randomly selected in the same period in the hospital as a control group.And we analysed the parturition manner,rate of flooding and puerperal fever,incidence of disease of baby,weight of baby and so on.Four:Statistical treatment Application of SPSS 13.0 statistical software for statistical analysis,and tabulation and graphics by Excel 2003,P＜0.05 indicated statistical significance. numerical data as mean and standard deviation.,and use the two-sample T-test or Mann - Whitney test.Categorical data were expressed as number and percentage,and use the x~2-test.the survival analysis is used the Log-Rank test.Results:1,the incidence about malignant tumors in pregnancy and malignant tumor type distribution.The detection rate of malignant tumors with Pregnancy is 0.682‰.Malignant tumors of reproductive system was 12,accounting for 35.3%(7 cervical cancer,5 ovarian cancer cases).Other malignant tumor were 22,accounting for 64.7%,(4 breast cancer,4 leukemia,3 nasopharyngeal carcinoma,3 liver cancer,1 non-Hodgkin's lymphoma,1 brain stem glioma,1 bone giant cell tumor,1 mucinous adenocarcinoma of the rectum,1 spinal glioma,melanoma,1 lung cancer and 1 squamous carcinoma of the maxillofacial).2,34 cases of pregnancy diagnosis and treatment(1) In the early six cases were diagnosed during pregnancy(13 week), accounting for 17.65%;15 cases in the medium term was diagnosed during pregnancy(week 14-27),accounting for 44.12%;at the late 8 cases were diagnosed during pregnancy(28 weeks),accounting for 23.53%;5 cases at the time production and post-natal was diagnosed,accounting for 14.70%.Symptoms to the time of diagnosis of 2.32±2.86 weeks gestational age for termination of pregnancy 29.06±10.56 weeks,the time from incidence to termination of pregnancy is 9.46±7.94 weeks. (2) during these 34 cases,there are nine cases of patients with tumor in the surgical treatment during pregnancy,three cases of patients with chemotherapy during pregnancy,six cases had radiotherapy.(3) 16 terminated the pregnancy cases,18 patients chose to continue pregnancy.3,malignant tumor in pregnancy to continue pregnancy and termination of pregnancy group situation(1)The average age of malignant tumor in pregnancy to continue pregnancy is 31.50±5.52 years old,pregnant at 1.89±0.90,production at 0.67±0.77, incidence of gestational age 26.09±8.51 weeks gestational diagnosis of 30.43±8.18 weeks,the incidence of time to diagnosis of 3.48±3.66 weeks,termination of pregnancy gestational age 35.87±2.78 weeks,maternal survival time of 22.87±34.96 for the month.Malignancy in pregnancy termination of pregnancy group the average age of 30.06±5.37 years old,pregnant at 2.25±1.00,production at 0.81±0.75,incidence of gestational age 18.57±10.25 weeks,19.73±10.22 diagnosis of gestational weeks,the incidence of time to diagnosis of 18.57±10.25 weeks termination of pregnancy gestational age 21.41±10.89 weeks,maternal survival time of 29.00±34.83 for the month.There is no significant difference of age(t=0.767,P=0.449),pregnant times(t=-1.108,P=0.276),production times (Z=-0.616,P=0.538),the mother of survival time(Z=-1.123,P=0.261) between the two groups(P＞0.05);there is statistically differences(P＜0.05)of incidence gestational age(t=2.260,P=0.031),diagnosis gestational age(t=3.387,P=0.002), the time of incidence to diagnosis(Z=-2.916,P=0.004),termination of pregnancy gestational age(Z=-4.125,P=0.000) between the two groups.(2) Malignancy in pregnancy to continue the five-year survival rate of pregnancy group 38.89%,meso-life span is 10 weeks;termination of pregnancy group of five-year survival rate of 43.75%,meso-life span is 24 weeks;Will depict the survival time of two survival curves,survival curves for survival analysis of the Log-Rank test:χ~2=0.596,P=0.440,there is no significant difference in survival time between the two groups.(3) Pregnancy incidence of malignant tumor to continue to pregnancy termination of pregnancy with maternal survival time to do Spearman correlation analysis,the results:r=0.454,P=0.078,there is no statistical significant.4,The situation of the malignancy in pregnancy to continue pregnancy group and the normal pregnancy control group,(1) The average age of Malignancy in pregnancy to continue pregnancy group is 31.50±5.52 years old,pregnant at 1.89±0.90 and production at 0.67±0.77. The average age of the control group is 30.25±5.41 years old,pregnant at 2.25±1.00,production at 0.81±0.75.There is no significant difference between the two groups in the progesterone times(t=0.094,P=0.926) and production times (t=-1.403,P=0.175),but in the age range(t=-2.762,P=0.007)(P＜0.05).(2) The termination of pregnancy of Malignancy in Pregnancy group is 35.87±2.78 weeks.15 cases of cesarean section;cesarean section rate of 83.3%;seven cases of postpartum hemorrhage,the occurrence rate was 38.9%;puerperal morbidity occurred in four cases,the occurrence rate of 22.2%.The control group's termination of pregnancy gestational is 38.70±1.39 weeks,27 cases of cesarean section, cesarean section rate of 27.0%,four cases of postpartum hemorrhage,the occurrence rate of 4%;puerperal morbidity occurred in four cases,the occurrence rate of 4%. There were significant differences in termination of pregnancy(t=4.233,P=0.000), cesarean section rate(χ~2=21.117,P=0.000),the rate of post-partum haemorrhage (χ~2=21.966,P=0.000),puerperal disease rates(χ~2=8.014,P=0.005)(P＜0.05).(3)The birth of Malignancy in pregnancy to continue pregnancy group weight at 2661.11±648.05g.There were 10 premature examples,rates in 55.6%;four cases of low birth weight infants,with the rate of 22.2%;three cases of neonatal asphyxia, (mild neonatal asphyxia) with the rate of 16.7%.The birth of Normal pregnancy group weight at 3242.55±449.60g.There were 7 premature examples,rates in 7%;7 cases of low birth weight infants,with the rate of 7%;three cases of neonatal asphyxia,(mild neonatal asphyxia) with the rate of 7%.There were significant differences in the birth weight(t=4.694,P=0.000) and all the three kinds of rates(P＜0.05).Conclusion1,Malignancy in Pregnancy isn't a rare complication.It's common to see malignant cervical cancer and ovarian cancer,non-malignant tumors in the reproductive system of breast cancer,leukemia,nasopharyngeal cancer andliver cancer.2,The rate of gesarean section,premature delivery,postpartum hemorrhage and puerperal disease were found significantly increased in the pregnant women with Malignancy in Pregnancy.3,The birth of Malignancy in Pregnancy group had apparant low weight,and the premature infants,low birth weight infants,as well as the incidence of neonatal asphyxia was significantly increased. 4,The high mortality rate among pregnant women with malignant tumors,when the follow-up to 30 months,60 percent of patients have died,but termination of pregnancy and during pregnancy should not extend the survival time of patients.5,This set of data indicates there was no correlation between the maternal survival time and the period from cancer incidence in pregnancy to terminat.To sum up,the incidence of pregnancy with low malignant tumors,the survival rate low,a greater impact on maternal and child,termination of pregnancy and should not extend the survival time.Malignant tumors during pregnancy should deal with the treatment of tumor at follow up in accordance with basic principles of tumor stage, gestational age of pregnancy,the patient wishes to develop a individuality treatment plan. |
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