General care is directed towards the particular organs or systems affected by the malignancy itself and its treatment. Thus all mothers require careful antenatal assessment with particular attention to haematological, cardiac, renal and hepatic function etc., with decisions concerning anaesthetic management made accordingly. Some mothers may knowingly have put their lives at risk in order to give the fetus the best chance of survival, and this must be respected when managing their analgesia and anaesthesia.
In trophoblastic neoplastic disease, uterine evacuation may be adequate surgical management but hysterectomy may be required in more invasive disease, especially in older women. Surgery may also be required for torsion of, or haemorrhage into, ovarian cysts. Chemotherapy maybe required if human chorionic gonadotro-phin levels remain elevated or in metastatic disease. In terms of anaesthetic management, the above considerations should be taken into account and appropriate measures taken regarding investigation (including liver and thyroid function blood tests and chest radiography), monitoring and management. General anaesthesia is usually recommended since uterine bleeding may be rapid and severe, and blood should be cross-matched and ready before surgery.
Was this article helpful?