title: Anesthetic management during labor and delivery: a 21-year review of women with cancer in a tertiary care center.
abstract: OBJECTIVE
  To describe the anesthetic management of labor and delivery in patients presenting with cancer during pregnancy at one institution.
  
  
  METHODS
  Retrospective data collection of pregnant cancer patients who delivered between January 1988 and December 2009.
  
  
  METHODS
  University-affiliated teaching hospital.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, ON M5G 1X5, Canada. uma.tharmaratnam@UHN.ca
authors.forename: Umamaheswary
authors.initials: U
authors.lastname: Tharmaratnam
authors.forename: Mrinalini
authors.initials: M
authors.lastname: Balki
mesh_terms: D000328:Adult; D000765:Anesthesia, Conduction / Q000379:methods; D000768:Anesthesia, General / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000379:methods*; D002585:Cesarean Section / Q000379:methods; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000473:pathology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000473:pathology*; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors