///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Cesarean section in a parturient with lingual squamous cell carcinoma and a C4 fracture

Abstract Number: 95
Abstract Type: Case Report/Case Series

Michael D. Maile M.D.1 ; Alexandra S. Bullough M.D.2

Introduction

As women delay becoming pregnant, more pregnancies will be complicated by rarely encountered comorbidities. We report the successful anesthetic management of a 39 yo parturient undergoing an elective cesarean section with a stage IVB squamous cell carcinoma (SCC) of the tongue. Oral-cavity squamous-cell carcinoma accounts for 2-3% of all malignancies. However, only 6.7% of patients with oral cancer are under the age of 45.

Case Report

A 39 yo, G3 P1 ASA 4 patient presented for cesarean section at 29 weeks gestation from the ICU. Her pregnancy was complicated by diagnosis of a lingual SCC at 17 weeks gestation. The patients social history comprised a 20 year, half pack smoking background associated with moderate alcohol intake. In her second trimester, she had lost over 50 lbs. At 26 weeks gestation the patient sustained a pathologic C4 fracture associated with bilateral upper extremity weakness.

The unstable cervical fracture was treated conservatively with a Miami J cervical collar. The patient arrived in theatre breathing spontaneously via a tracheostomy which had been created due to airway compromise and copious secretions. She was placed in a supine position with a 20 incline of the upper body. The uterus was manually displaced to the left. Standard monitors were placed, her head stabilized and cervical collar removed. After preoxygenation via the tracheostomy, 50 mg of propofol and 20 mg of cisatracurium were administered intravenously. A size 6.0 cuffed armored endotracheal tube replaced the patients 6.5 uncuffed tracheostomy tube. Anesthesia was maintained with oxygen, nitrous oxide and a propofol infusion. Blood pressure was supported with intermittent boluses of phenylephrine. EBL was 800mls. A baby boy weighing 1.24 kg was delivered with Apgar scores of 8 & 9 at one & five minutes respectively. Post-operatively, the patient was transferred back to the ICU. The patients condition deteriorated and she died two weeks after her cesarean section.

Discussion

During pregnancy, optimization of chemo-radiation therapy is difficult as many chemotherapeutic agents have a deleterious effect on the fetus. Our patient received chemotherapy and radiation treatment from 23 weeks gestation. The patients prognosis was poor and pursuing more rigorous chemotherapy over maintenance of fetal well-being would have made little difference to maternal outcome.

The obstetric team initially planned to deliver the fetus at 32 weeks gestation but due to maternal deterioration a decision was made to deliver the fetus earlier.

Carcinoma and the parturient highlights not only the difficult maternal anti-cancer treatment and life & death decisions that impact the fetal outcome but also emphasizes that multidisciplinary communication and sensitive management are essential to optimize parturient care.

References

1. Son YH, Kapp DS. Oral cavity and oropharyngeal cancer in a younger population. Cancer. 1985;55:441-4.

SOAP 2009