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Old 10-30-2012
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ObGyn Third trimester ovarian carcinoma

A 30 year old woman in 33rd gestational week of pregnancy has been diagnosed with a stage 1 cancer of the left ovary requiring surgical treatment without chemotherapy. What could be the best course of action?

A. Give corticosteroids to promote lung maturity and deliver the child as soon as possible since removal of the ovary could terminate the pregnancy.
B. Extend the pregnancy to term before beginning surgery since it is only a stage I cancer.
C. Proceed with the surgery but anticipate premature delivery anytime soon because an ovary was removed.
D. Proceed with the surgery as treatment will unlikely affect the pregnancy.
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[QUOTE=greater_infinity;158548]A 30 year old woman in 33rd gestational week of pregnancy has been diagnosed with a stage 1 cancer of the left ovary requiring surgical treatment without chemotherapy. What could be the best course of action?

A. Give corticosteroids to promote lung maturity and deliver the child as soon as possible
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C. Proceed with the surgery but anticipate premature delivery anytime soon because an ovary was removed.
Just an guess
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Old 10-31-2012
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i go with d
after second trimester ovary can be removed any time
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i also think it as D......thanks
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Quote:
Originally Posted by greater_infinity View Post
A 30 year old woman in 33rd gestational week of pregnancy has been diagnosed with a stage 1 cancer of the left ovary requiring surgical treatment without chemotherapy. What could be the best course of action?

A. Give corticosteroids to promote lung maturity and deliver the child as soon as possible since removal of the ovary could terminate the pregnancy.
B. Extend the pregnancy to term before beginning surgery since it is only a stage I cancer.
C. Proceed with the surgery but anticipate premature delivery anytime soon because an ovary was removed.
D. Proceed with the surgery as treatment will unlikely affect the pregnancy.
My answer is D)
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Old 10-31-2012
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After first trimester > Placenta doesn't need the Corpus Luteum (ovary) to synthesize Progesterone > so ovaries can be removed.
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The answer is D. Removal of the ovaries from the 3rd month to term is unlikely to affect the pregnancy because during this period, the placenta produces sufficient progesterone and estrogen to sustain the pregnancy.

From ovulation to 10 days after, the corpus luteum produces progesterone in response to LH from maternal pituitary. This prepares the uterus for implantation. Without fertilization, progesterone decreases maternal LH production by feedback inhibition and the corpus luteum regresses.

If fertilization occurs, the corpus luteum is rescued by the hCG which is already adequately produced by the trophoblasts 10 days after ovulation. hCG is similar to LH and functions to sustain the corpus luteum, which is then enabled to continue producing progesterone to sustain pregnancy. hCG secretion peaks up to the 3rd month of pregnancy, but corpus luteum function is only essential from implantation to the 2nd month of pregnancy.

From the 3rd month to term, the placenta is able to synthesize progesterone on its own relying purely on availability of cholesterol (supplied by LDL's) and not on hCG or LH levels. Thus corpus luteum is no longer crucial at this point and the ovaries can be removed and the pregnancy continues.
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As for the estrogen, corpus luteum stimulation by maternal LH or by hCG also leads to estrogen (estradiol) production.

From the 3rd month to term, the placenta produces estrogen (estriol) with help from the fetus. Fetal pituitary produces ACTH stimulating the fetal adrenal cortex to produce fetal androgen (DHEAS, a weak androgen). DHEAS is further modified by the fetal liver and finally converted by the placenta to estriol.
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D. Proceed with the surgery as treatment will unlikely affect the pregnancy.
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