Urinary Tract Infection at 9 Weeks, Vasculitis at 13 Weeks, Neck Pain at 21 Weeks. Frequent Flyer Syndrome? A Case Study of Non-Hodgkin's Lymphoma Diagnosed at 27 Weeks
Article first published online: 14 JUN 2012
© 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses
Journal of Obstetric, Gynecologic, & Neonatal Nursing
Special Issue: 2012 Convention Proceedings
Volume 41, Issue s1, page S169, June 2012
How to Cite
Caruso, A. (2012), Urinary Tract Infection at 9 Weeks, Vasculitis at 13 Weeks, Neck Pain at 21 Weeks. Frequent Flyer Syndrome? A Case Study of Non-Hodgkin's Lymphoma Diagnosed at 27 Weeks. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41: S169. doi: 10.1111/j.1552-6909.2012.01363_11.x
- Issue published online: 14 JUN 2012
- Article first published online: 14 JUN 2012
- non-Hodgkin's lymphoma in pregnancy;
- interdisciplinary teams;
- best outcomes
Lymphoma is now the fourth most diagnosed malignancy during pregnancy, occurring in approximately 1:6,000 births. With the delay in childbearing and the increase in primiparous maternal age it can be expected that cancer will be diagnosed more frequently in pregnant women. Since non-Hodgkin's lymphomas occur in an older patient population than Hodgkin's lymphomas, this may account for fewer reports of non-Hodgkin's lymphoma patients with coexisting pregnancies. When a diagnosis is made, issues surrounding decisions regarding the approach to treatment options are extremely complex and must include the medical and obstetric health of both the mother and fetus.
A gravida 1, para 0, 25-year-old married patient had multiple encounters with the healthcare system during her first and second trimester until being diagnosed with non-Hodgkin's lymphoma at 27 to 28 weeks. An interdisciplinary team was formed and invites went out to the perinatology, oncology, obstetrics, spiritual services, palliative care, and social services departments. The patient's initial plan was to start the first round of chemotherapy to help with her pain and reduce the nodules in her neck. It was clear to the team that a plan with ongoing communication must be determined. Less than 2 weeks later the patient was readmitted for intractable head pain. A lumbar puncture confirmed cancer cells in her cerebral spinal fluid. She would now need to be treated with chemotherapy in her brain through placement of an Ommaya reservoir, a device surgically implanted under the scalp used to carry medicine to the brain and spinal cord. Her delivery was scheduled and would be complicated by her extremely low platelet and white blood cell counts.
The most critical and challenging issues for the team involved managing the patient's pain, treating her cancer, and monitoring maternal well-being and fetal development. Her care was complicated by her physical location in the hospital, family dynamics, and need for prenatal education and rest. She gave birth to a female infant vaginally at 30 + 6 weeks.
The diagnosis of cancer during pregnancy is rare but may increase in the future. Through an interdisciplinary team effort that includes the obstetric nurse, we can accept the challenges that accompany the pregnant oncology patient and promote evidenced-based best practice to provide continuity of physical, psychological, and spiritual care for optimal outcomes.