Best practice advice: management

Surgery can be performed whenever indicated and feasible, irrespective of gestational age Obstetric, anesthetic, and neonatal teams should be involved from the locally agreed gestational age of viability Radiotherapy, especially of the pelvis, is avoided during pregnancy where possible, but may be conducted in the first trimester Chemotherapy can be administered according to standard non‐pregnant regimens in most cases after the first trimester, with surveillance for fetal growth and preterm delivery, and monitoring of the mother for any toxicity or adverse effects Most supportive treatments while on chemotherapy are safe There are limited data on targeted therapy, although treatments can be individualized Biological agents can be used in pregnancy with MDT discretion The impact of delaying treatment, where needed, on maternal health, including mortality, should be clearly discussed and documented

Pragmatic practice advice

Maternal cancer treatment and continuation of pregnancy is to be preferred rather than medically induced (very) preterm delivery Where expertise is not available to deliver cancer care for a pregnant woman, an earlier transfer to a center that can support both maternal and fetal care is recommended. Failing this, a shared care model can be developed with support from a regional tertiary unit