///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

carcinomas in pregnancy:Review of cases in a high risk obstetric center over a period of 20 years

Abstract Number: 185
Abstract Type: Case Report/Case Series

Uma M Tharmaratnam MBBS, FRCPC1 ; Mrinalini Balki MD2

Purpose- Cancer is the second most common cause of mortality during reproductive years. We performed a retrospective chart review of patients with a diagnosis of cancer during pregnancy at Mount Sinai Hospital (MSH) over a period of 20 years to determine the incidence of different types of cancers and their influence on the management of labor and delivery.

Method- After REB approval, charts of patients who presented with cancers during pregnancy at MSH between January 1988 and December 2008 were reviewed. Data on patient demographics, details of cancer, mode of delivery, anesthetic techniques and complications were collected.

Results- Out of 111,049 patients who delivered during this period, 83% were identified with cancer during pregnancy (total 98 deliveries). The frequency of various types of cancers was breast (18%), lymphoid tissue (17%), reproductive organs (14%), leukemia (13%), thyroid (10%) gastrointestinal (8%), brain (4%), bone (4%) and others (12%). Fifty two percent of patients were newly diagnosed with cancer during pregnancy whereas 48% patients had received treatment prior to the pregnancy. The average maternal age was 32.75 years and the body mass index was 28.56.2 kg/m2. Patients who were treated before pregnancy had an uneventful perinatal course, whereas those with severe symptoms had expedited delivery after ensuring fetal lung maturity. The mean gestational age at induction was 333 weeks. Table 1 shows the obstetrical and anesthetic management of these patients. A total of 82% patients received regional anesthesia except those with metastatic bone cancers, sepsis and thrombocytopenia. There were no major peripartum complications.

Conclusion- The incidence of cancer during pregnancy at our institution was 0.09%. The management of cancer during pregnancy varies from case to case based on the gestational age, type and symptoms of cancer at presentation. Regional anesthetic techniques can be used safely in most cases without any adverse sequelae.

Ref- 1) Current opinion in otolaryngology & head and neck surgery 2004, 12:76-81;

2) Canadian journal of anesthesia 2001 48: 575-583

Table 1. Labour and delivery management of patients with carcinomas during pregnancy

Management of labor N (%)

Induction 18 (21.7)

Spontaneous Labour 31 (37.3)

Delivery

Spontaneous Vaginal 28 (33.7)

Assisted Vaginal 9 (10.8)

Elective C-section 33 (39.8)

Emergency C-section 10 (12.0)

Labour Analgesia

Regional 36 (43.4)

IV Patient controlled analgesia 5 (6.0)

None 7 (8.4)

Anesthesia for C-section

Regional 34 (41.0)

GA 8 (9,6)

SOAP 2010