Reproductive outcome after anesthesia and operation during pregnancy: A registry study of 5405 cases

Mazze, Richard I.; Källén, Bëngt

doi:10.1016/0020-7292(90)90410-m

Cited by 317 publications

(117 citation statements)

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“…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%

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: Surgerymentioning

confidence: 99%

Pregnancy-Associated Breast Cancer: A Literature Review

Barnes

Newman

2007

Surgical Clinics of North America

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Section: Discussionmentioning

confidence: 99%

“…The prognosis of breast cancer is independent of the pregnancy, and termination of the pregnancy is not indicated [1]. Surgery is not contraindicated during the first trimester, but could be associated with low birth weight or premature labour [2].Skin-sparing mastectomy was chosen over breast-conserving surgery in this patient to prevent radiotherapy during her pregnancy, as well as considering the higher local relapse rates after breast-conserving treatment in young women [3,4]. In younger women, 10-years risk of recurrence of 20% can be reduced to 10% by radiotherapy boost [5].…”

mentioning

confidence: 99%

Breast cancer and pregnancy: diagnosis and treatment options

Velde

Sonke

Rutgers

2009

Breast Cancer Online

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A 36-year-old woman had noticed a lump in her right breast, just after she had discovered she had been pregnant for about 6 weeks. At referral to our clinic, on physical examination a palpable mass was found in the upper quadrant of her right breast, sized 2 cm in diameter.Diagnostic mammography and ultrasound were performed elsewhere and showed an uncertain density on mammography and an uncertain hypoechoic structure on ultrasound cranial to the righter mammilla, sized 15 mm in diameter. Utrasound of the axilla showed no suspected lymph nodes. A core biopsy proved an adenocarcinoma.After discussing the different options, the patient preferred a skin-sparing mastectomy with nipple banking and sentinel node biopsy. The sentinel node was retrieved by 85 MBq technetium-99m nanocolloid intra-tumoural injection, without using blue dye.At histopathology the tumour was T1 (15 mm) in size, B&R grade II; the sentinel node was tumournegative after multiple slicing and IHC staining with Cam 5.2; oestrogen receptor was 100% positive and progestin receptor was 100% positive; HER2-neu was negative. The margins were free. The Mammaprint s showed a low-risk signature, that is no distant metastases within at least 5 years.Since the patient was in her first trimester of pregnancy, and the child was very much desired, finally, the patient opted for endocrine therapy. She will receive tamoxifen and ovarian suppression by LHRH agonist after her child delivery. She decided not to have adjuvant chemotherapy, particularly considering the high hormone responsiveness of the tumour and the Mammaprint low risk. In addition, due to her young age, she was referred to the genetic counselling department. DiscussionBreast cancer is the second most common cancer in pregnant women. The prognosis of breast cancer is independent of the pregnancy, and termination of the pregnancy is not indicated [1]. Surgery is not contraindicated during the first trimester, but could be associated with low birth weight or premature labour [2].Skin-sparing mastectomy was chosen over breast-conserving surgery in this patient to prevent radiotherapy during her pregnancy, as well as considering the higher local relapse rates after breast-conserving treatment in young women [3,4]. In younger women, 10-years risk of recurrence of 20% can be reduced to 10% by radiotherapy boost [5]. However, older radiation courses showed to be dangerous to the foetus [6], and although no data exist on effects of modern radiotherapy, it is not advised in the first trimester until after delivery (Dutch guidelines: http://www.oncoline.nl).The sentinel node biopsy was performed using a lower dose of nanocolloid than usual. In a recent review, the axillary lymph node dissection is advocated as opposed to sentinel lymph node biopsy [7]. However, according to others, we believe that it can be performed safely [8,9], since -even with normal intra-tumoural dosage -the dose to the foetus is proven to be negligible [9]. We used a dose Correspondence to: E. J. Th. Rutgers, The

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“…Pregnant women are at higher risk of tooth decay for several reasons, including increased acidity in the oral cavity, sugary dietary cravings, and limited attention to oral health [2]. Dental caries or unattended oral infection can assume grave proportions during pregnancy due to an upheaval of the physiological system and severe septic complications and an increased risk of adverse foetal outcomes has been reported [3]. Fortunately the incidence of these severe maxillofacial infections during pregnancy is low; however a couple of cases of Ludwig's angina during pregnancy have been reported in the literature [4].…”

Section: Introductionmentioning

confidence: 99%