Management of general surgical problems in the pregnant patient

Melnick, David M.; Wahl, Wendy L.; Dalton, Vanessa K.

doi:10.1016/j.amjsurg.2003.11.023

Cited by 113 publications

(58 citation statements)

References 66 publications

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“…This in part, is attributed to the engorgement and physiologic hypertrophy of the pregnant or lactating breast. It is no longer accepted that pregnancy is an independent risk factor for poor prognosis, and there is no clear evidence to support that the hyperestrogenic state of pregnancy contributes to development and rapid growth [24]. Table 3 references the general pathology of pregnancy-associated breast cancer.…”

Section: Prognosismentioning

confidence: 99%

“…The safety of surgical intervention during pregnancy is well supported, but it may be deferred until the 12th gestational week given that the risk of spontaneous abortion is greatest during the first trimester [7,11,24,43,44]. Historically, a modified radical mastectomy was considered the standard of care for all resectable disease during each trimester.…”

Section: Surgerymentioning

confidence: 99%

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Pregnancy-Associated Breast Cancer: A Literature Review

Barnes

Newman

2007

Surgical Clinics of North America

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Breast cancer, along with cervical cancer, is one of the most commonly diagnosed cancers of pregnancy. Most would define gestational breast cancer as breast cancer that is diagnosed during pregnancy, lactation, and up to 12 months post-partum. The diagnostic and therapeutic implications in this clinical setting are special. These women typically present with a more advanced-stage disease that carries an associated poorer prognosis. Physicians thus are challenged to balance aggressive maternal care with appropriate modifications that will ensure fetal protection. . Of women diagnosed with breast cancer younger than 40 years, only approximately 10% will be pregnant [2,3]. These data certainly suggest a low incidence of pregnancy-associated breast cancer. In fact, historically, the incidence is estimated at 1 in 3000 pregnancies [4][5][6]. Despite the overall low incidence, however, gestational breast cancer is one of the most common pregnancy-associated malignancies, second only to cervical cancer [4,6]. Notably, many have offered that this incidence will only increase as more women delay childbearing until later in life [4,7]. This concern is based on the fact that pregnancy-associated breast cancer is age-related, and women

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Section: Prognosismentioning

confidence: 99%

Section: Surgerymentioning

confidence: 99%

Pregnancy-Associated Breast Cancer: A Literature Review

Barnes

Newman

2007

Surgical Clinics of North America

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“…With the evolution of pregnancy, higher intra-abdominal pressure and decreased pressure of the lower esophageal sphincter may increase the risk of aspiration. In this context the cricoid pressure must be used to prevent aspiration during intubation [2]. In these patients, the tone and gastric motility also decreases as a result of increased levels of progesterone and displacement of the stomach by enlarged uterus [17].…”

Section: Physiological Changes Of Pregnancymentioning

confidence: 99%

“…There is a 60% increase in oxygen demand and the mechanical displacement of the abdominal organs leads to a decrease in residual volume. The increased oxygen consumption and increased minute ventilation increases tidal volume about 40%, which rapidly decreases PO 2 during apneia [2]. Maternal obesity, pre-eclampsia, or both can accentuate the risk of hypoxaemia associated with induction of and emergence from general anaesthesia [16].…”

Section: Physiological Changes Of Pregnancymentioning

confidence: 99%

“…An average of 1-2% of pregnant women in developed countries is submitted to anesthesia for non-obstetrical surgery with a range of 80,000 procedures per year [1][2][3][4][5]. Intra-abdominal pathologies are the most commonly encountered surgical emergencies in pregnant women and diagnosis is hampered by factors such as nausea, vomiting, constipation, abdominal distension and pain related to normal pregnancy.…”

Section: Introductionmentioning

confidence: 99%

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Anesthesia for Non-Obstetrical Surgery during Pregnancy

Mandim¹

2014

General Med

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The number of surgical procedures in gravid women unrelated to pregnancy itself has been increased over years. In such cases, one must keep in mind the responsibility for two patients, the optimization and maintenance of maternal homeostasis, avoiding alterations on uteroplacental perfusion that can bring harm to the fetus. This review focus on safety to performing these procedures during pregnancy, considering the advances in the prevention and treatment of obstetric and fetal morbidity related to anesthesia. Background and Objectives:Despite research advances, there is still much controversy in the anesthetic management of obstetric patients. Several studies have demonstrated the safety of anesthesia in this group of patients. In this review an analysis of anesthetics used in clinical practice is proposed as well as the technique to be chosen and its effects on the mother and fetus in non-obstetric surgery during pregnancy.

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