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Keywords:

  • lymphoma;
  • brain tumor

Poster Presentation

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  2. Poster Presentation

Background

A brain tumor is an extremely rare but serious complication during pregnancy that jeopardizes the lives of the mother and fetus. There is risk for significant morbidity or mortality. Physiologic changes during pregnancy may worsen the neurological symptoms, have profound effect on tumor growth, and affect the pharmacokinetics of chemotherapeutic agents. Such changes include water retention, engorgement of vessels, increased plasma volume, third spacing in the amniotic fluid, and increased renal clearance and hepatic metabolism of drugs. The timing of chemotherapy, neurosurgical intervention, and birth should be tailored to each patient. Concern for fetal outcomes while treating maternal cancer raises therapeutic, ethical, moral, and social dilemmas.

Case

We recently worked with a 38-year-old gravida 6, para1 with a lymphoma metastasis to the brain. On admission at 26 and 4 weeks gestation, she was anemic from previous chemotherapy with a hemoglobin of 11.3 and hematocrit of 33.8. The fetal heart rate was 148. She presented with an altered mental status, nausea, vomiting, dysnea, and had experienced a seizure at home. Magnetic resonance imaging showed a herniated large brain lymphoma with potential for rupture.

The significance of her worsening neurologic status resulted in a collaborative multidisciplinary approach to her care. The goal of medical management was to treat the cause, prevent further neurologic deterioration, provide supportive care, prolong the gestation, and maintain the well-being of mother and fetus. Interventions included daily rounds with the medical and nursing team to discuss the status of the mother and fetus. Ongoing assessment and anticipation of the patient's needs were completed by the nurses. It was critical that any change in her condition was evaluated for further progression of the disease. Dietary and psychosocial needs were also addressed. Extensive counseling and planning are already occurring for postpartum chemotherapy and/or surgery.

Conclusion

The diagnosis of a lymphoma brain tumor requires planning for the anticipated birth and well-being of the infant and long-term planning for the mother. From this case we learned “on the spot” education for nursing and a multidisciplinary approach to care. This included multiple physicians and representatives from nursing specialties, dietary, social work, and case management meeting frequently to discuss the latest condition of the patient. This strong collegial relationship focused on the patient's and infant's welfare and well-being.