Patient currently pregnant (any trimester). Triggers MFM (maternal- fetal medicine) co-ma...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-PREGNANCY-ACTIVE`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-NCCN-BCELL-2025` `SRC-NCCN-BREAST-2025`

Red Flag Origin

Definition	Patient currently pregnant (any trimester). Triggers MFM (maternal- fetal medicine) co-management, gestational-age-stratified treatment selection (no antineoplastic in first trimester except in rare emergencies; second/third trimester chemotherapy for selected regimens with documented safety — anthracyclines without taxanes, weekly paclitaxel; methotrexate, radiation, ICI, and most targeted agents contraindicated).
Clinical direction	hold
Category	reproductive-status

Trigger Logic

{
  "any_of": [
    {
      "finding": "pregnancy_active",
      "value": true
    },
    {
      "comparator": ">",
      "finding": "gestational_age_weeks",
      "threshold": 0
    }
  ],
  "type": "composite_score"
}

Notes

ESMO clinical practice guideline on cancer in pregnancy (Peccatori 2013, updated). First-trimester teratogenicity: no chemotherapy except emergency hematologic salvage; counsel on therapeutic abortion vs delayed therapy. Second/third trimester safety profile (Loibl, Amant): doxorubicin + cyclophosphamide AC for breast — safe; weekly paclitaxel — safe; trastuzumab — contraindicated (oligohydramnios); ICI — limited data, defer to postpartum; rituximab — neonatal B-cell depletion but reversible, often acceptable; ABVD for Hodgkin — safe in T2/T3; BEACOPP — avoid; R-CHOP for DLBCL — feasible T2/T3 with MFM. Delivery 2-3 weeks after last cycle to allow nadir recovery. Direction `hold` for any first-trimester systemic; modulated to `de-escalate` later — engine should consume gestational age.

Used By

Red flag

RF-PREGNANCY-PLANNING - Patient planning pregnancy within next 12 months. Triggers fertility preservation referra...