Haematological malignancies during pregnancy: a systematic review of necessary services in the Australian context

Abstract

Background: Haematological malignancies diagnosed during pregnancy are rare, with increasing incidence, presenting unique therapeutic, social and ethical challenges for treating teams, patients and their family. There are no national guidelines regarding appropriate referral pathways, resources and services for the management of these patients.

Aims: To conduct a systematic review of the literature to identify the multidisciplinary team members required for optimal care of pregnant patients with haematological malignancies. These data will be used to evaluate the capabilities of Australian health networks to provide coordinated care.

Methods: A systematic review of the literature in MEDLINE and SCOPUS databases was conducted. Eligible studies focused on pregnant Australian patients with haematological malignancies, exploring care models, specialist teams and services utilised. This was then used to generate a map of Australian hospitals that can service this patient demographic.

Results: Essential team members include haematologists, maternal-fetal medicine specialists, anaesthetists, midwives, intensive care specialists, psychologists and social workers. Services utilised include haematology, maternity, intensive care, tertiary imaging, operating theatre, pharmacy and perinatal mental health services. Utilising these data, 25 hospitals can manage these patients.

Conclusions: This study identified the necessary healthcare practitioners, services and hospitals available that can manage this patient cohort. Future research should focus on determining ideal treatment regimens, timing of therapy throughout gestation, establishing a national patient registry and implementing a cancer care plan and frameworks for best practice care. A centralised referral pathway leveraging telehealth will allow expedient, multidisciplinary action and equity in access to all women across Australia.

Keywords: Australia; haematological malignancy; haematology; leukaemia; lymphoma; pregnancy.

Figure 1

PRISMA flow diagram outlining methodology for article selection.

Figure 2

Percentage of multidisciplinary team involvement and recommendation from articles analysed in the systematic review. GP, general practitioner; ICU, intensive care unit; MFM, maternal–foetal medicine. Other* includes specialties that were only mentioned in a single article and include radiation oncology, pharmacy, pathology, geneticist, nephrology, gastroenterology, cardiology, teratogenicity specialist, and reproductive cryobiology.

Figure 3

Geographical map highlighting the hospitals having the appropriate resources to manage pregnant patients diagnosed with a haematological malignancy. ^aOnly manages the antenatal care and delivery in patients with haematological malignancies. These sites require patients to have their treatment at a nearby cancer centre that is not co‐located with the specialist obstetric hospital. ^bCan manage the treatment of pregnant patients with haematological malignancies but require the antenatal care and delivery to be managed at a nearby specialist obstetric hospital with MFM services. ^cTertiary centres offering comprehensive care for these patients, including treatment, antenatal care and delivery, all in one location.

Figure 4

Core service utilisation identified from the literature review. ICU, intensive care unit; MFM, maternal–fetal medicine; NICU, neonatal intensive care unit; U/S, ultrasound.