Successful Spontaneous Twin Pregnancy Following Bone Marrow Transplant and Gastric Cancer Surgery - A Case Report

Sep 23, 2026

Pregnancy following bone marrow transplantation (BMT) and gastric cancer treatment is rare. The case report describes a 22-year-old woman with prior severe aplastic anemia treated with allogeneic BMT and later subtotal gastrectomy for gastric adenocarcinoma. In 2024, she conceived spontaneously with a dichorionic–diamniotic twin pregnancy. Early ultrasound surveillance showed reassuring fetal growth, but later she developed extensive lower-limb deep vein thrombosis and obstructive uropathy requiring anticoagulation and ureteric stent placement. Elective cesarean delivery occurred at 35+6 weeks and both infants were delivered without complications.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Introduction

Case Report

Clinical Course and Management

Conclusions

Keywords

e-ISSN 1941-5923 © Am J Case Rep, 2026; 27: e951965 DOI: 10. 12659/AJCR.951965 Received: 2025.11.01 Accepted: 2026.02.18 Available online: 2026.03.02 Published: 2026.04.12 ABCDEFG ABDFG BCDEF ABCEFG Corresponding Author: Financial support: Conflict of interest: 1 2 2 1 Successful Spontaneous Twin Pregnancy Following Bone Marrow Transplant and Gastric Cancer Surgery: A Case Report Hessa Khalid Sulaiman Almuhaisen Sara Abdulaziz AlShubat Ashwaq Nasser AlRaqeeb Elham Awad Saeed AlQarni Hessa Khalid Sulaiman Almuhaisen, e-mail: [Hessamuhaisen@gmail.com](Hessamuhaisen@gmail.com) None declared None declared Authors’ Contribution: Study Design A Data Collection B Statistical Analysis C Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G 1 Department of Obstetrics and Gynecology, King Fahad Military Medical Complex (KFMMC), Dhahran, Saudi Arabia 2 Department of Maternal–Fetal Medicine, King Fahad Military Medical Complex (KFMMC), Dhahran, Saudi Arabia Patient: Female, 22-year-old Final Diagnosis: Gastric cancer • succesful pregnancy • transplant Symptoms: Twins pregnancy Clinical Procedure: — Specialty: Hematology • Obstetrics and Gynecology Objective: Unusual clinical course Background: Pregnancy following bone marrow transplantation (BMT) and treatment for gastric cancer is rare because of gonadotoxic conditioning regimens, major abdominal surgery, and the overall burden of chronic illness. Reports of spontaneous twin pregnancy after both allogeneic BMT and gastrectomy are exceptionally uncommon. Case Report: We describe the case of a 22-year-old woman with a history of severe aplastic anemia treated with allogeneic BMT (February 2022), who subsequently underwent subtotal gastrectomy for gastric adenocarcinoma (May 2022). She conceived spontaneously with a dichorionic–diamniotic twin pregnancy in 2024, several years after completion of oncologic treatment, without fertility preservation. Early pregnancy was uneventful, with reassuring serial ultrasound scans and normal fetal growth. In the second trimester, she developed extensive lowerlimb deep vein thrombosis (superficial femoral vein thrombosis confirmed by compression Doppler ultrasound) requiring therapeutic anticoagulation with enoxaparin 1 mg/kg twice daily, followed by obstructive uropathy due to ureteric compression that necessitated double-J stent insertion. Maternal nutritional status and weight gain were closely monitored with serial laboratory assessment (including hemoglobin, ferritin/iron indices, vitamin B12, folate, and albumin) given her prior gastrectomy. Multidisciplinary care involving maternal–fetal medicine, hematology, oncology, urology, and anesthesia teams guided surveillance and delivery planning. At 35+6 weeks of gestation, an elective cesarean section was performed because of dichorionic twin gestation, prior major abdominal surgery, and ongoing therapeutic anticoagulation requiring coordinated perioperative planning. Two live infants with appropriate birthweights and good Apgar scores were delivered, and the postoperative course was uncomplicated for both mother and neonates. Conclusions: This case illustrates that successful twin pregnancy is possible after BMT and gastric cancer surgery when individualized, multidisciplinary care and careful thromboembolic and urological surveillance are provided. It also supports the need for structured preconception counseling, fertility follow-up, and pragmatic monitoring protocols for high-risk pregnancies in young cancer and transplant survivors. Keywords: Stomach Neoplasms • Bone Marrow Transplantation • Pregnancy, Multiple Full-text PDF: [https://www.amjcaserep.com/abstract/index/idArt/951965](https://www.amjcaserep.com/abstract/index/idArt/951965) 1581 — — 21 Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated

FAQs

Why is pregnancy after bone marrow transplant and gastric cancer surgery considered rare?

Because gonadotoxic conditioning regimens, major abdominal surgery, and the overall burden of chronic illness greatly reduce fertility and complicate pregnancy. Reports of spontaneous twin pregnancy after both allogeneic BMT and gastrectomy are exceptionally uncommon.

What complications occurred during the twin pregnancy?

In the second trimester, she developed extensive lower-limb deep vein thrombosis requiring therapeutic anticoagulation with enoxaparin. She also developed obstructive uropathy due to ureteric compression, necessitating double-J stent insertion.

What was the delivery plan and outcome?

At 35+6 weeks, an elective cesarean section was performed due to dichorionic twin gestation, prior major abdominal surgery, and ongoing anticoagulation. Two live infants with appropriate birthweights and good Apgar scores were delivered, and the postoperative course was uncomplicated for both mother and neonates.

Sep 23, 2026

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