You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
all chemotherapy agents are potentially teratogenic and there is a potential long - term effect on the offspring . concerns always exist regarding the mother s health .
chemotherapy is contraindicated in the first trimester because of the high rate of abortion and abnormal fetal development .
malformations were present in 83.3% of fetuses when chemotherapy was administered during the first trimester ; in contrast , malformations have not been reported in most cases in which chemotherapy was administered during the second or third trimesters .
literature contains numerous reports regarding the use of different combinations of chemotherapeutic agents including the combination of cisplatin / carboplatin , cyclophosphamide and paclitaxel in pregnancy with untoward effects and with good response to therapy and subsequent delivery of healthy baby .
we presented a case of 37-year old woman , on her sixth pregnancy ( gravida 6 ) , having three deliveries ( para 3 ) and a history of 2 miscarriages was referred to the antenatal clinic at khartoum teaching hospital , sudan , with a routine 16 weeks ultrasound report showing : a 16 weeks single fetus , and bilateral asymptomatic multilocular - solid cystic adnexal masses with maximum diameter of 8x9 cm in the right ovary and 7x6 cm in the left ovary ( figure 1 ) .
the patient had no remarkable medical problems and no previous family history of endometrial , ovarian , colorectal , or breast cancer .
the laboratory tests performed were within normal range except elevated serum levels of lactate dehydrogenase .
biological markers : ca125 ( normal range : < 35 iu / ml ) , ca15 - 3 ( normal range < 35 iu / ml ) , and ca19 - 9 ( normal range < 35 iu / ml ) levels were 1015 u / ml , 203 u / ml , and 26 u / ml , respectively .
multidisciplinary counseling was applied : surgical interventions and prospect of laparotomy findings , maternal and fetal risks , prospects of chemotherapy treatment during pregnancy and after delivery were discussed with patient and family .
it showed the presence of bilateral ovarian masses ( maximum diameter 9x10 cm in the right ovary and 7x6 cm in the left ovary ) with intact capsules , and two omental nodules ( maximum diameter 6 cm ) ( figures 2 and 3 ) .
bilateral salpingo - oophorectomy , infracolic omentectomy , appendectomy , peritoneal washing , and multiple biopsies of the parietocolic and prevescical peritoneum , parieto - visceral adhesions , and diaphragm were performed .
histopathology assessment of the multilocular ovarian cysts , omentum nodules and lymph nodes showed : bilateral malignant tumors formed of wide trabeculae and sheet of small malignant cells with dark ovoid nuclei with many mitosis consistent with bilateral small cell ovarian carcinoma ( grade 2 ) , in both ovaries and the omental nodules .
the patient was staged as having an international federation of gynecology and obstetrics ( figo ) stage iiic disease .
detailed counseling of the patient and her family with multidisciplinary staff has been done and written informed consent was obtained for initiation of chemotherapy with preservation of pregnancy .
following surgery the patient received adjuvant chemotherapy with cyclophosamide ( 600 mg / m intravenously on day one every four weeks for six cycles ) and carboplatin ( 300 mg / m by intravenous injection on day 1 every four weeks for six cycles ) .
the patient showed good tolerance to treatment with mild gastrointestinal and hematological toxicity observed in the last cycle of treatment .
ca125 levels dropped from 371 u / ml at the beginning of chemotherapy treatment , to normal levels ( < 35 u / ml ) following the second course of treatment .
exploratory laparotomy with cesarean delivery followed by total hysterectomy , and multiple biopsies were carried out at 38 weeks of gestation .
no apparent residual disease was documented at surgery , and final histopathological diagnosis revealed no secondary tumor tissues in the uterus , with section of omentum showing area of fibrosis and foreign body giant cells reaction with no secondary deposits .
the outcome was a female infant 2900 g with apgar scores of 9 and 10 at 1 and 5 min , respectively .
the placenta appeared normal at the time of delivery and showed no tumor at histology .
the patient has been followed by ultra - sound and radiographically with computerized tomography scans of the abdomen and chest radiographs , all of which have been negative . in addition , clinical examinations and serum tumor markers ( ca125 ) have been within normal limits .
we report a rare case of small cell ovarian cancer during pregnancy to highlight the effect of the intervention in particular the chemotherapy on pregnancy outcome .
the management of early - stage ovarian carcinoma diagnosed during pregnancy should be started without delay . with regard to the chemotherapy administration during pregnancy european society of medical oncology ( esmo ) guidelines recommended the following : the decision to administer chemotherapy should follow the same guidelines as in non - pregnant patients . in practice , it is possible to administer chemotherapy from 14 weeks gestational age onwards with specific attention to prenatal care . to allow the bone marrow to recover and to minimize the risk of maternal and fetal sepsis and hemorrhage ,
delivery should be planned at least 3 weeks after the last cycle of chemotherapy , and chemotherapy should not be given after 35 weeks since spontaneous labor becomes more probable .
, it is suggested that in addition to gestational dating , routine ultra - sound examination of the adnexae should be considered . because cancer with pregnancy is rare , there is limited number of researches to guide women and their doctors , however some reports showed that pregnancy has no deleterious effect on the prognosis , and that pregnancy should be preserved whenever possible and that prognosis and treatment success
data of effect of chemotherapy during pregnancy was largely derived from case reports and case series , intra - uterine growth restriction and low birth weight , prematurity , fetal toxicity , miscarriage have been reported .
stated that chemotherapy in early pregnancy ( during the period of organogenesis ) is associated with a high risk of miscarriage and congenital malformation .
these consequences will be of fewer incidences when treatments are initiated in the second trimester .
however , an increased number of fetal complications are still observed even when chemotherapy is used in late pregnancy .
proved that the outcome of the children exposed to chemotherapy during pregnancy is not different from the general population , however in their report they found that prematurity was common and was associated with impaired cognitive development .
therefore , iatrogenic preterm delivery should be avoided when possible . the current standard regimen for adjuvant chemotherapy to treat epithelial ovarian carcinoma
patients receiving carboplatin during the second trimester have been reported with no serious effect on the fetus .
termination of pregnancy must be considered in women presenting with advanced stage disease in early pregnancy warranting chemotherapeutic treatment . until now , the long - term health effects on children exposed to chemotherapeutic agents in utero remain unknown as there are no long - term studies .
no specific information is available regarding the teratogenic effects of carboplatin or paclitaxel in human studies ( table 1 ) .
potential long - term risks include : compromised physical and neurological development , an increased risk of malignancy in childhood and adult life , and the possibility of mutagenesis of germ - line tissue resulting in an increased risk of malignancy in future generations .
women must be counseled with regard to the administration of chemotherapy in pregnancy and should be advised of the necessary long- term follow up of their children .
there is no convincing evidence that a synergistic increase in malformation occurs with the use of multi - agent regimes as opposed to treatment with one cytotoxic agent . regarding the selection of chemotherapeutic agents in our case , multi - agents therapy with cyclophosamide and carboplatin
cyclophosamide and platinum - based chemotherapy have been reported to be generally well tolerated and not associated with toxicity in the newborn .
the addition of paclitaxel during pregnancy was also excluded not only in consideration of the recent controversies raised in some studies , but also because of major concerns expressed by the patient about the lack of the experience available at that time of the use of taxanes in her specific clinical situation .
however many studies have shown that paclitaxel used alone or in combination with other agents in maternal ovarian cancers , has no significant fetal toxicity when used during the second or third trimester . in conclusion
the findings from this case concluded that prognosis and quality of the patient s life should be a priority , chemotherapy during the second trimester seems to be safe however , potential risks of this interventions still has to be considered .
ovarian cancer during pregnancy is a rare event . 
 little is known about the treatment of this condition due to lack of prospective randomized trials and cohort studies . in this paper 
 the authors reported a rare case of small cells ovarian cancer , diagnosed at 16 weeks of gestation , treated with conservative surgery at 18 weeks and chemotherapy . at week 38 , the patient underwent caesarean section and delivered a healthy baby girl . 
 staging surgery was then carried out followed by adjuvant chemotherapy . 
 thus the findings from this case concluded that prognosis and quality of the patient s life should be a priority , chemotherapy during the second trimester seems to be safe however , potential risks of this interventions still has to be considered .