Pregnancy in a Young Patient with Metastatic HER2-Positive Breast Cancer-Between Fear of Recurrence and Desire to Procreate

Breast cancer is the most frequent neoplasm among women and the second leading cause of death by cancer. It is the most frequent cancer diagnosed during pregnancy. Pregnancy-associated breast cancer is defined as breast cancer that is diagnosed during pregnancy and/or in the postpartum period. Data about young women with metastatic HER2-positive cancer who desire a pregnancy are scarce. The medical attitude in these clinical situations is difficult and nonstandardized. We present the case of a 31-year-old premenopausal woman diagnosed in December 2016 with a stage IV Luminal HER2-positive metastatic breast cancer (pT2 N0 M1 hep). The patient was initially treated by surgery in a conservative manner. Postoperatively, the presence of liver metastases was found by CT investigation. Consequently, line I treatment (docetaxel l75 mg/m² iv; trastuzumab 600 mg/5 mL sq) and ovarian drug suppression (Goserelin 3.6 mg sq at 28 days) was administered. After nine cycles of treatment, the patient's liver metastases had a partial response to the therapy. Despite having a favorable disease evolution and a strong desire to procreate, the patient vehemently refused to continue any oncological treatment. The psychiatric consult highlighted an anxious and depressive reaction for which individual and couple psychotherapy sessions were recommended. After 10 months from the interruption of the oncological treatment, the patient appeared with an evolving pregnancy of 15 weeks. An abdominal ultrasound revealed the presence of multiple liver metastases. Knowing all the possible effects, the patient consciously decided to postpone the proposed second-line treatment. In August 2018, the patient was admitted in the emergency department with malaise, diffuse abdominal pain and hepatic failure. Abdominal ultrasound found a 21-week-old pregnancy which had stopped in evolution, multiple liver metastases and ascites in large quantity. She was transferred to the ICU department where she perished just a few hours later. Conclusions/Discussion: From a psychological standpoint, the patient had an emotional hardship to make the transition from the status of a healthy person to the status of a sick person. Consequently, she entered a process of emotional protection of the positive cognitive distortion type, which favored the decision to abandon treatment and try to complete the pregnancy to the detriment of her own survival. The patient delayed the initiation of oncological treatment in pregnancy until it was too late. The consequence of this delay in treatment led to the death of the mother and fetus. A multidisciplinary team worked to provide this patient with the best medical care and psychological assistance throughout the course of the disease.

Appropriate Delivery Timing in Fetuses with Fetal Growth Restriction to Reduce Neonatal Complications: A Case-Control Study in Romania

(1) Background: The main challenge in cases of early onset fetal growth restriction is management (i.e., timing of delivery), trying to determine the optimal balance between the opposing risks of stillbirth and prematurity. The aim of this study is to determine the likelihood of neonatal complications depending on the time of birth based on Doppler parameters in fetuses with early onset fetal growth restriction; (2) Methods: A case-control study of 205 consecutive pregnant women diagnosed with early onset FGR was conducted at the Obstetrics Clinic of the Municipal Emergency Hospital in Timisoara, Romania; The case group included newborns who were delivered at the onset of umbilical arteries absent/reversed end-diastolic flow, and the control included infants delivered at the onset of reversed/absent ductus venosus A-wave. (3) Results: The overall neonatal mortality rate was 2.0%, and there was no significant statistical difference between the two study groups. In infants delivered up to 30 gestational weeks, grades III/IV intraventricular hemorrhage and bronchopulmonary dysplasia were statistically significantly more frequent in the control group. Moreover, univariate binomial logistic regression analysis on fetuses born under 30 gestational weeks shows that those included in the control group are 30 times more likely to develop bronchopulmonary dysplasia and 14 times more likely to develop intraventricular hemorrhage grades III/IV; (4) Conclusions: Infants delivered according to the occurrence of umbilical arteries absent/reversed end-diastolic flow are less likely to develop intraventricular hemorrhage grades III/IV and bronchopulmonary dysplasia.