Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON M5G 1X5, Canada.
J Clin Anesth. 2012 Nov;24(7):524-30. doi: 10.1016/j.jclinane.2012.02.009. Epub 2012 Sep 21.
To describe the anesthetic management of labor and delivery in patients presenting with cancer during pregnancy at one institution.
Retrospective data collection of pregnant cancer patients who delivered between January 1988 and December 2009.
University-affiliated teaching hospital.
Clinical data on cancer diagnosis and treatment and obstetric, neonatal, and anesthetic management of the study patients were compiled. Analysis was done based on whether the cancer was diagnosed before or during pregnancy.
The incidence of cancer during pregnancy at our institution was 0.1%. No difference was noted in the incidence of cancer diagnosed before and during pregnancy was noted. Women with a cancer diagnosis during pregnancy had more clinical symptoms, a higher rate of inductions (37% vs 11%; P = 0.0002) and premature deliveries (48% vs 20%; P = 0.0003) than those with a cancer diagnosis before delivery. No differences between groups in neonatal outcome were noted. Most patients received regional anesthesia for labor and delivery (75%); a significant number (22%) also received general anesthesia for cesarean section. Life-threatening complications were seen in those with mediastinal tumors or metastases.
Women with cancer diagnosed during pregnancy are likely to require prompt therapeutic intervention and have a potential for premature delivery. Anesthetic management should be tailored to the individual type of cancer, depending on the severity of symptoms, stage of cancer, and associated systemic involvement.
描述在一家医院中，妊娠期癌症患者分娩时的麻醉管理情况。
对 1988 年 1 月至 2009 年 12 月期间分娩的妊娠合并癌症患者进行回顾性数据收集。
大学附属医院。
对研究患者的癌症诊断和治疗以及产科、新生儿和麻醉管理的临床数据进行了编译。分析基于癌症是在妊娠前还是妊娠期间诊断的。
本机构妊娠期癌症的发病率为 0.1%。在妊娠前和妊娠期间诊断出癌症的发生率无差异。与在分娩前诊断出癌症的患者相比，在妊娠期间诊断出癌症的患者有更多的临床症状，引产率（37%对 11%；P = 0.0002）和早产率（48%对 20%；P = 0.0003）更高。两组新生儿结局无差异。大多数患者接受区域麻醉分娩（75%）；相当一部分（22%）还接受全身麻醉剖宫产。有纵隔肿瘤或转移的患者出现危及生命的并发症。
在妊娠期间诊断出癌症的女性可能需要及时进行治疗，并有可能早产。麻醉管理应根据个体癌症类型进行定制，取决于症状的严重程度、癌症分期和相关的全身受累情况。
