Anesthetic management during labor and delivery: a 21-year review of women with cancer in a tertiary care center

Study ObjectiveTo describe the anesthetic management of labor and delivery in patients presenting with cancer during pregnancy at one institution.DesignRetrospective data collection of pregnant cancer patients who delivered between January 1988 and December 2009.SettingUniversity-affiliated teaching hospital.MeasurementsClinical 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.Main ResultsThe 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.ConclusionWomen 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.