Documentation of Pregnancy Risk Assessment and Pregnancy Among Women Presenting for Gynecologic Oncology Consultation
Documentation of Pregnancy Risk Assessment and Pregnancy Among Women Presenting for Gynecologic Oncology Consultation
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DOI：
10.1097/igc.0000000000000576
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发表时间：
2016-01-01
影响因子：
4.8
通讯作者：
Eisenhauer, Eric L.
中科院分区：
文献类型：
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作者：
Crafton, Sarah;Nekkanti, Silpa;Eisenhauer, Eric L.
目的本研究的目的是描述三级保健中心妇科肿瘤医生所见的育龄人群的妊娠风险评估、生殖目标和妊娠发生率。方法对2000年1月至2011年12月经妇科肿瘤科医师评估的18 ~ 45岁女性进行回顾性图表分析。提取的数据包括：诊断、癌症治疗、胎次、妊娠危险因素（如月经模式、性活动和避孕措施的使用）、生殖目标、转诊类型和妊娠。使用描述性统计来描述人口的特征。结果517名妇女符合条件并被纳入综述。中位年龄为31岁，最常见的诊断是宫颈癌、子宫内膜癌和癌前病变。大多数病人都是多胎。70%的人接受手术治疗，58%的人经历了手术性不孕。初次就诊时记录的生殖数据的完整性包括：47%的人有避孕计划，54%的人有性活动/性行为，37%的人有个人生殖目标。初诊时怀孕15例，随访时怀孕21例，共43例妊娠（9例为1次以上妊娠）。对于初次就诊后仍保持生育能力的患者，中位数（范围）为2（0-25）次就诊，32%的患者在随访时记录了避孕计划。结论：在妇科肿瘤医生的初次咨询中，患者的生殖目标和妊娠危险因素没有得到一致的解决。在妇科癌症诊断的评估和治疗过程中，这种一致性的缺乏可能会增加患者意外怀孕的风险，并可能导致错过保留生育能力的机会。计划怀孕和计划外怀孕在这一人群中的发生率与美国育龄妇女相似，强调了这一人群对生殖咨询的需求。
Objective The aim of the study was to describe pregnancy risk assessment, reproductive goals, and incidence of pregnancy among the reproductive age population seen by gynecologic oncologists at a tertiary care center.Methods A retrospective chart review was conducted among 18- to 45-year-old women evaluated by a gynecologic oncologist from January 2000 to December 2011. Data abstracted included the following: diagnosis, cancer treatment, parity, pregnancy risk factors (eg, menstrual patterns, sexual activity, and use of contraception), reproductive goals, type of referral, and pregnancy. Descriptive statistics were used to describe the characteristics of the population.Results Five hundred seventeen women were eligible and included in the review. Median age was 31 years with most common diagnoses being cervical cancer, endometrial cancer, and premalignant disease. Most patients are multiparous. Seventy percent were treated surgically, with 58% experiencing surgical sterility. Completeness of reproductive data documented at initial visit included the following: 47% with a contraception plan, 54% sexual activity/practices, and 37% with personal reproductive goals reviewed. Fifteen patients were pregnant at the initial visit, and 21 patients pregnant during follow-up, representing 43 pregnancies (9 patients had more than 1 pregnancy). For those maintaining fertility after the initial visit, there was a median (range) of 2 (0-25) visits with 32% documenting a contraception plan at follow-up visits.Conclusions A patient's reproductive goals and risk factors for pregnancy are inconsistently addressed during initial consultation with the gynecologic oncologist. This lack of consistency potentially increases patients' risk for unplanned pregnancy during evaluation and treatment of a gynecologic cancer diagnosis and potentially results in a missed opportunity for fertility preservation. Planned and unplanned pregnancy occurs in this population at a rate similar to that of US women of reproductive age, underscoring the need for reproductive counseling in this population.