ajog.

org Poster Session I

99 Cervical cancer in pregnancy: management and
outcomes
Management of cervical cancer in pregnancy
1 3 2
Catherine Bigelow , Neil Horowitz , Annekathryn Goodman ,
Whitfield Growdon2, Marcela Del Carmen2, Anjali Kaimal2
1
Brigham & Women’s Hospital/Massachusetts General Hospital, Obstetrics &
Gynecology, Boston, MA, 2Massachusetts General Hospital, Vincent
Department of Obstetrics & Gynecology, Boston, MA, 3Brigham & Women’s
Hospital, Obstetrics & Gynecology, Boston, MA
OBJECTIVE: To describe the management of patients with cervical
cancer diagnosed in pregnancy and compare their outcomes to
nonpregnant women with similar baseline characteristics.
STUDY DESIGN: We conducted a retrospective chart review of all
patients diagnosed with cervical cancer in pregnancy and matched
them 1:2 with contemporaneous nonpregnant women of the same
age diagnosed with cervical cancer of the same stage. Patients were
identified using ICD-9 codes and the Dana-Farber/MGH Cancer
Registry. Data were analyzed with STATA version 10.1.
RESULTS: 28 cases of cervical cancer diagnosed in pregnancy were
identified from 1997-2013. The majority were Stage IBI (Figure).
32% (9/28) of women terminated the pregnancy; these women were
more likely to be diagnosed in the first trimester (11.6 vs 19.9 wks,
p<0.05). For those who did not terminate, mean GA at delivery was
36.8 weeks. Pregnancy complications were uncommon. In com-
parison to nonpregnant women, women undergoing radical hys-
terectomy in pregnancy or postpartum were more likely to receive a
transfusion (35.7% vs 6.7%, p<0.05); complication rates were
otherwise similar, as were survival rates. In comparison to pregnant
patients who survived, those who died were more likely to be Stage II SD ¼ standard deviation; CI ¼ confidence interval; GA ¼
or greater at the time of diagnosis (p<0.05). None of the pregnant gestational age; EBL ¼ estimated blood loss
women who died delayed treatment due to pregnancy.
CONCLUSION: Gestational age at diagnosis is an important determi- 100 Comparison of two methods of fetal heart rate
nant of management of cervical cancer in pregnancy, underscoring interpretation using an on-line testing tool
the need for expeditious workup of abnormal cervical cytology in Aaron Epstein1, Brian Iriye2, Lyle Hancock2, Edward Quilligan1,
pregnancy. Of women who chose to continue the pregnancy, most Pamela Rumney1, Judy Hancock2, Mark Ghamsary3,
delivered in the late preterm period without significant obstetric Deborah Wing1
1
complications. For women undergoing radical hysterectomy in the Univeristy of California, Irvine, Obstetrics and Gynecology, Orange, CA,
2
peripartum period, other than an increased risk of transfusion, High Risk Pregnancy Center, Las Vegas, NV, 3Loma Linda University, Epi,
complication rates are similar to nonpregnant women undergoing Loma Linda, CA
this procedure. Women who died were more likely to be of advanced OBJECTIVE: To compare the Quilligan-Hon (QH) method of fetal
stage at the time of diagnosis. This information may be useful in heart rate (FHR) interpretation to the Caldeyro-Barcia (CB) method
counseling women facing the diagnosis of cervical cancer in among groups of obstetrical care providers using an on-line inter-
pregnancy. active testing tool.
STUDY DESIGN: Contemporary interpretation of FHR patterns is largely
Cervical cancer diagnosed in pregnancy by stage at based on the tenets of QH. This method differs from the CB method in
recording speed and classification of decelerations. The latter uses a
time of diagnosis paper speed of 1 cm/min and classifies decelerations referent to uterine
contractions as Type I or II dips, compared to conventional classifica-
tion as early, late, or variable with paper speed of 3 cm/min. It is
hypothesized that 3 cm/min monitoring speed leads to over-analysis of
FHR interpretation. We de-identified from 80 FHR tracings the
terminal 20-30 minutes prior to delivery. A website was created to view
these tracings using the standard QH method and adjusted the same
tracings to the 1 cm/min monitoring speed for the CB method. We
invited three of each: MFM experts, practicing MFMs, MFM fellows,
obstetrical nurses and CNM’s to participate. After completing an
introductory tutorial and quiz, they were asked to interpret the FHR
tracings whose order was scrambled and predict maternal and neonatal
outcomes using both methods. Their results were compared to those of
our expert, Edward Quilligan, and compared between groups. Analysis
was performed using three measures: percent classification, Kappa and
adjusted Gwet-Kappa (AC1) (p <0.05 considered significant.)
RESULTS: Overall our results show from moderate to almost perfect
agreement, both between and within examiners (Table 1).
CONCLUSION: We examined the agreement of FHR interpretation
with defined set of rules among a number of different obstetrical
practitioners using three different statistical methods. All results
indicated moderate-to-substantial agreement among the clinicians

Supplement to JANUARY 2015 American Journal of Obstetrics & Gynecology S67