Background: Pregnancy-associated cancer has an increasing incidence of 2·7% per annum between 1994 and 2013, attributed to advancing maternal age, improved diagnostic techniques and health-system engagement. Haematological malignancies pose a unique therapeutic challenge when diagnosed during pregnancy. Clinicians must consider both maternal and fetal wellbeing, with the goal of delivering optimal curative therapy for the woman, and a successful pregnancy outcome for mother and baby. A multidisciplinary approach to diagnosis and management of haematological malignancies in pregnancy is paramount, although guidelines and clinical pathways to enable clinically effective implementation are lacking, tools WHO (2019) advise guide evidence-based healthcare, with the aim to translate clinical practice guideline recommendations into clinical processes of care within the unique culture and environment of a health care institution, improving patient safety.
Methods: The Haematology in Obstetrics and Women’s Health Collaborative published a position statement on investigation and multidisciplinary management of pregnancy associated acute leukaemia or aggressive lymphoma, endorsed by the Councils of the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) and the Haematology Society of Australia and New Zealand (HSANZ), guiding development of a clinical pathway.
Results: A clinical pathway was created, encompassing multidisciplinary team care, contacts, history, pathology tracker, medications, current issues summary, antenatal care and imaging, dietetics, chemotherapy, psychosocial needs, lactation, intrapartum care encompassing antibiotics, anaesthetic, VTE and PPH prevention, postnatal care including contraception, and neonatal care.
Conclusions: Development of clinical pathway enables standardised implementation of new evidence-based guidelines for care in acute leukaemia and aggressive lymphomas in pregnancy.