Cisplatin/epoetin-alfa/unspecified steroids
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Cisplatin/epoetin-alfa/unspecified steroids Drug exposure during pregnancy, low birth weight and anaemia: 2 case reports
A case report described a 27-year-old pregnant woman, who developed anaemia during treatment with cisplatin for cervical cancer, and a male neonate, who born with low birth weight and anaemia following in-utero exposure to cisplatin. Additionally, the woman received epoetin-alfa and unspecified steroids during pregnancy [maternal routes and duration of treatment to to reaction onset not stated; not all dosages and outcomes stated]. The pregnant woman (gravida 1, para 0) presented at 15 weeks of gestation to a hospital in Italy with vaginal bleeding and pelvic pain. She was admitted and underwent multiple investigations. Thereafter, she was diagnosed with FIGO stage IB2 squamous cell cervical cancer. She declined the termination of pregnancy, and therefore, from 18 weeks of gestation, she started receiving neoadjuvant chemotherapy (NACT) with cisplatin 75 mg/m2 every 3 weeks (21 days cycle). However, following the second cycle of NACT, she developed grade III anaemia (haemoglobin 6.8 mg/dL). Therefore, she was treated with epoetin-alfa [epoietin alfa] 10000U three times per week for 3 weeks. She received total four cycles of NACT, with total cisplatin dose of 540mg. At the fourth cycle of chemotherapy, the haemoglobin level was noted to be 11.7 mg/dL. Doppler ultrasonography of the umbilical and uterine arteries was normal and did not show intrauterine growth restriction. At 30 weeks of gestation, she had stable cancer disease, and a caesarean delivery was scheduled after induction of fetal lung maturity. Therefore, she was treated with a course of unspecified antenatal steroids, and she underwent amniocentesis twice, until fetal lung maturity was achieved. At 32 weeks of gestation, she underwent a caesarean section along with radical hysterectomy, pelvic lymphadenectomy and bilateral oophorectomy. She delivered a viable, healthy male neonate, weighing 1920g (low birth weight), who measured 43cm with a head circumference of 31cm. The Apgar score was noted to be 8.8 at 1 minute and 5 minutes. After 15 mins, the neonate developed respiratory distress syndrome, for which he required nasotracheal intubation. Also, he was treated with exogenous surfactant delivered endotracheally. He exhibited anaemia, for which he received a blood transfusion on day 2. It was noted that he developed acute respiratory distress secondary to prematurity and anaemia. He was de-tubated on day 2, and he needed mechanical ventilation (nasal CPAP) until day 6. He was discharged in a good general condition after 27 days. Her post-operative course was uneventful; however, she developed metastases. Four weeks after delivery, unspecified chemotherapy and radiotherapy was initiated. Two years after delivery, she died due to respiratory failure, and the boy did not have any evidence of abnormalities in neuropsychomotor development (at the last follow-up). It was noted that the chemotherapy with cisplatin increased the risk of
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