Best practice advice

Women with cancer in pregnancy planning delivery should be counseled that there is a higher risk of CS and postpartum hemorrhage Delivery should be planned for 3 or more weeks after stopping 3‐weekly chemotherapy to enable recovery from maternal and fetal myelosuppression. Shorter interval (weekly) chemotherapy may need a 7–10‐day washout period Vaginal birth is recommended unless contraindicated Termination of pregnancy in the first or second trimester is a woman‐centered, MDT, and ethical decision and may be considered in advanced cancer, where treatment options safe in pregnancy are not the right choice for maternal benefit, upon maternal request, or where end‐of‐life care is being considered Continuous monitoring during labor is recommended, with a low threshold for initiating antibiotics at the first sign of infection The infant should be assessed by a neonatal team for infection, toxicity from chemotherapy, and for the presence of metastases where placental metastases have been identified End‐of‐life care should consider the mother and newborn's bonding time, which should not be withheld

Pragmatic practice advice

Ensure an appropriate washout period of chemotherapy before delivery Steroids for fetal lung maturity and delivery should be considered in a unit with neonatal support facilities when planning an elective preterm birth Breastfeeding is encouraged if the mother is not undergoing, or is awaiting the initiation of, postnatal treatment Charities like Mummy's Star can offer psychological support for mothers and families