Suitable mode of delivery in a pregnant lady with Cervical carcinoma is :
Early invasive: (Stage IB, IIA). Treatment options depend on--gestational age, tumor stage, metastatic evaluation and maternal desire to continue pregnancy. First trimester: Radical hysterectomy (with the fetus in uterus), pelvic lymphadenectomy and aoic node sampling are done. Oopheropexy at the time of hysterectomy may be done. Postoperative irradiation following evaluation of prognostic factors. Third trimester: Radical hysterectomy, pelvic lymphadenectomy after classical cesarean delivery. Dissection may be easy but bleeding is often more in pregnancy. Second trimester: Management decisions are more difficult. Options are: (i) Neoadjuvant chemotherapy (platinum based) - continuation of pregnancy 7 to 15 weeks (fetal maturation) - Classical cesarean delivery and radical hysterectomy, pelvic lymphadenectomy (risk of prematurity far outweighs the risk of chemotherapy). (ii) Abdominal hysterectomy or classical cesarean section - Radical surgery. Post- operative irradiation as on evaluation procedure. ADVANCED INVASIVE DISEASE: (Stage III, IV): First trimester: Chemotherapy and external beam irradiation - spontaneous aboion (2-5 weeks) or uterine evacuation - Brachytherapy. Second or third trimester: Classical cesarean delivery - neoadjuvant chemotherapy and irradiation (external beam and brachytherapy). Reference: Dutta's Textbook of Obstetrics 7th edition page no 308
Classical cesarean section
Lower segment cesarean section
Normal vaginal delivery
Forceps application
Medical, surgical and gynaecological illness complicating pregnancy