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首页> 外文期刊>BMC Cancer >Epirubicin: a new entry in the list of fetal cardiotoxic drugs? Intrauterine death of one fetus in a twin pregnancy. Case report and review of literature
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Epirubicin: a new entry in the list of fetal cardiotoxic drugs? Intrauterine death of one fetus in a twin pregnancy. Case report and review of literature

机译：表柔比星：胎儿心脏毒性药物列表中的新条目？双胎妊娠中一名胎儿的子宫内死亡。病例报告和文献复习

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Background Current knowledge indicate that epirubicin administration in late pregnancy is almost devoid of any fetal cardiotoxicity. We report a twin pregnancy complicated by breast cancer in which epirubicin administration was causatively linked to the death of one twin who was small for gestational age (SGA) and in a condition of oligohydramnios and determined the onset of a transient cardiotoxicity of the surviving fetusewborn. Case presentation A 38-year-old caucasic woman with a dichorionic twin pregnancy was referred to our center at 20 and 1/7?weeks for a suspected breast cancer, later confirmed by the histopathology report. At 31 and 3/7?weeks, after the second chemotherapy cycle, ultrasound examination evidenced the demise of one twin while cardiac examination revealed a monophasic diastolic ventricular filling, i.e. a diastolic dysfunction of the surviving fetus who was delivered the following day due to the occurrence of grade II placental abruption. The role of epirubicin cardiotoxicity in the death of the first twin was supported by post-mortem cardiac and placental examination and by the absence of structural or genomic abnormalities that may indicate an alternative etiology of fetal demise. The occurrence of epirubicin cardiotoxicity in the surviving newborn was confirmed by the report of high levels of troponin and transient left ventricular septal hypokinesia. Conclusion Based on our findings we suggest that epirubicin administration in pregnancy should be preceded by the screening of some fetal conditions like SGA and oligohydramnios that may increase its cardiotoxicity and that, during treatment, the diastolic function of the fetal right ventricle should be specifically monitored by a pediatric cardiologist; also, epirubicin and desamethasone for lung maturation should not be closely administered since placental effects of glucocorticoids may increase epirubicin toxicity.
机译：背景技术目前的知识表明，妊娠晚期使用表柔比星几乎没有任何胎儿心脏毒性。我们报道了双胞胎妊娠并发乳腺癌，其中表柔比星的给药与一个胎龄不大且处于羊水过少情况下的双胞胎的死亡有因果关系，并确定了存活胎儿的短暂心脏毒性发作/新生。病例介绍一名38岁的白高龄妇女，有双绒毛双胎妊娠，在20和1/7周时被转诊到我们中心接受怀疑的乳腺癌治疗，后来被组织病理学报告证实。在第二个化疗周期后的第31和3/7周，超声检查表明一对双胞胎死亡，而心脏检查则发现单相舒张性心室充盈，即存活的胎儿的舒张功能障碍，由于第二天分娩而分娩。发生II级胎盘早剥。死后心脏和胎盘检查以及缺乏结构或基因组异常可能表明胎儿死亡的其他病因支持了表柔比星心脏毒性在第一个双胞胎死亡中的作用。肌钙蛋白水平高和短暂性左心室间隔运动不足的报道证实了存活的新生儿发生了表柔比星心脏毒性。结论根据我们的发现，我们建议在妊娠期间给予表柔比星之前应先筛查一些可能增加心脏毒性的胎儿疾病，例如SGA和羊水过少，在治疗过程中，应通过监测胎儿右心室的舒张功能小儿心脏病专家;同样，表皮柔比星和地塞米松用于肺成熟不应紧密给药，因为糖皮质激素的胎盘作用可能会增加表柔比星的毒性。

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