Table 2.

“Red flags” for diagnosis and follow-up of cervical cancer diagnosed during pregnancy.

At the time of diagnosis: General care Evaluate maternal psychological distress—refer for psychological support Tumor staging -Tumor staging (clinical evaluation, MRI without gadolinium) -Evaluate the need for surgical lymph node dissection Obstetrical care -Evaluate the term of the pregnancy (ultrasonography) -Evaluate fetal pre-existing conditions—prenatal screening and diagnosis (ultrasonography, blood samples, amniocentesis if necessary)

Treatment during pregnancy: General care Evaluate maternal psychological distress—refer for psychological support Chemotherapy -Exclude tumor progression under neoadjuvant chemotherapy (MRI without gadolinium) Obstetrical care -Evaluate fetal growth (ultrasonography) -Exclude fetal malformation (ultrasonography) -Exclude fetal anemia (doppler of the middle cerebral artery)

Before delivery: General care -Ensure an interval of 3 weeks between chemotherapy and delivery—research maternal thrombopenia or neutropenia (blood samples) -Evaluate maternal psychological distress—refer for psychological support Obstetrical care -Plan delivery with neonatologist unit

After delivery: General care Evaluate maternal psychological distress—refer for psychological support Tumor staging -Tumor staging on both local, nodal, and metastatic level (MRI, PET/CT) -Evaluate the need for adjuvant therapy Child care Long-term follow-up required with a trained pediatrician, particularly if neoadjuvant chemotherapy was performed during pregnancy

Abbreviations: MRI = Magnetic Resonance Imaging, PET/CT = Positron Emission Tomography/Computed Tomography.