Feto-maternal outcomes of pregnancy complicated by XXXX : a systematic review of literature.

@entity5 @entity43 @entity204 @entity158
UNASSIGNED: Although @entity5 diagnosed during pregnancy is rare, @entity43 (EOCs) comprise approximately one quarter to one half of cases of @entity43 diagnosed during pregnancy. The behavior of EOC during pregnancy and its implications for maternal and fetal outcomes is not well understood. In order to better define these outcomes, a systematic literature search was conducted in PubMed/MEDLINE using @entity43 " for the period from 1955 to 2013. The literature search identified 105 cases eligible for analysis. Clinical characteristics, pregnancy outcome, @entity5 characteristics, clinical management, and survival outcomes were all evaluated. Serious adverse events were defined as complications related to EOC that resulted in severe morbidity or mortality for the mother and/or fetus. The mean age of cases was 31.6 years. The most common histology was serous (47.6%), followed by mucinous (27.6%) and endometrioid types (10.5%). The most common presenting symptom was abdominal or pelvic @entity158 (26.7%) while incidentally detected @entity5 accounted for one third of cases. The majority of cases were stage I at diagnosis (63.8%) followed by @entity5 (24.8%), and the median @entity5 size was 12cm. Live births occurred in 81.3% of cases, and of the remainder 72.2% were due to elective termination. Intrapartum surgery primarily took place in the second trimester (43%) with fetal conservation in 61.9% of operations. Over half of cases received chemotherapy (55.2%), approximately one third of which received it during the pregnancy (36.2%). Among the 21 cases treated with chemotherapy during pregnancy, there was no association with small for gestational age or fetal malformations. Serious adverse events occurred in 21.9% of cases, of which the most common was @entity5 rupture during pregnancy (10.5%). Three (2.9%) maternal @entity204 following surgery during pregnancy and five (6.4%) neonatal @entity204 were reported. Gestational age at @entity5 diagnosis (2-year overall survival rate, 1st trimester 94.6%, 2nd trimester 88.8%, and 3rd trimester 72.9%, p=0.041) type of histology (serous 88.1%, mucinous 84.6%, endometrioid 89.5%, clear cell 100%, mixed type 75.0%, and undifferentiated 30.0%, p<0.01), stage (stage I 96.9%, stage II 85.7%, stage III 56.3%, and stage IV 25.0%, p<0.01), and serious adverse events (yes versus no, 68.1% versus 92.2%, p=0.041) were significantly related to maternal overall survival in univariate analysis. In multivariate analysis, stage III/IV disease remained the independent prognostic factor associated with decreased maternal overall survival (stage III, hazard ratio 44.6, p<0.01; and stage IV, hazard ratio 399, p<0.01). In conclusion, although the majority of EOC cases during pregnancy resulted in live birth, maternal and neonatal mortality needs to be considered in the counseling and management of these pregnancies.
