Pregnancy with carcinoma cervix.

A 26-year-old lady presented to our emergency department on April 6, 2008, referred from a rural hospital as threatened abortion, with bleeding per vagina and pain abdomen, carrying 5 months’ pregnancy. She had been bleeding per vagina from the April 5 and gave history of occasional spotting. She also gave history of post-coital bleeding over a period of 8–9 months. She had two previous successful pregnancy outcomes; both times she had delivered vaginally and both her children were fine and healthy. Her last childbirth was 6 years back. She never had any complications in her previous pregnancies. After her last pregnancy, she was using oral contraceptives, and this pregnancy resulted from improper intake of oral contraceptives. On admission, we examined the patient and found she was pale, her pulse was 120/min, and blood pressure was 130/90 mm Hg. Uterus was 20 weeks’ size on abdominal examination, and she could perceive fetal movements. On Doppler examination, the fetal heart rate was 140/min and regular. On per speculum examination of cervix, a bleeding mass could be seen on the anterior lip of cervix. On gentle per vaginal examination, the mass was hard and irregular, and cervix was tubular with parous os. Provisional diagnosis of pregnancy with carcinoma cervix was made. We did blood requisition and blood transfusion, gave her antibiotics, catheterized the patient, and gave vaginal packing with Botroclot. Next day, we got a whole abdomen ultrasonography done which showed an 18-week-sized single live fetus, without any congenital anomaly of approximate weight 220 grams. The scan also showed bulky and irregular cervix, but rest of the organs were normal. We went for pre-operative investigations, which were found to be normal after three units of blood transfusion(Haemoglobin 10 gram percent). The patient was taken for Examination Under Anaesthesia and cervical biopsy on the April 9. She was clinically diagnosed to be a case of carcinoma cervix stage I b2. Biopsy report came on the April 19 which showed moderately differentiated infiltrating squamous cell carcinoma of cervix. Proper counseling was done to the patient party, and the patient herself was informed regarding the severity of the disease and management of the case and with informed consent, Saha S. K., Professor Mandal T., Associate Professor Department of Obstetrics and Gynaecology, Eden Hospital, Medical College, 88, College Street, Kolkata 700 073, India