Ovarian cancer or pregnancy,

ovarian cancer or pregnancy

Several conditions are more frequent in pregnancy: appendicitis, cholecystitis, adnexal torsion, adnexal mass, trauma, breast disease, cervical dysplasia or cancer, bowel obstruction. When a pregnant patient has to undergo surgery, the obstetrician, the general surgeon, or the orthopedist, the neurosurgeon as appropriate, together with the anesthetist and the neonatologist must consult each other, establishing the plan of action and performing accordingly.

Among all procedures, abdominal interventions have the most significant impact, either considering laparotomy, or laparoscopy.

There are several advantages of laparoscopic surgery during pregnancy: decreased pain, smaller abdominal incisions, smaller scars, fewer incisional hernias, shorter recovery and hospitalization time, early normal bowel function and mobilization.

There are also ovarian cancer or pregnancy possible disadvantages, such as injuring the pregnant uterus, decreasing uterine blood flow by increased intraabdominal pressure or even carbon dioxide absorption by mother and fetus.

Data supporting laparoscopy in pregnancy suggest that laparoscopy can be done safely during pregnancy.

Intervenţia chirurgicală în timpul sarcinii poate fi o provocare, deoarece trebuie avute în vedere atât viaţa mamei, cât şi viabilitatea fătului, iar ambii pot fi afectaţi în timpul acestor proceduri. Câteva afecţiuni sunt mai frecvente în timpul sarcinii: apendicita, colecistita, torsiunea anexială, masele anexiale, traumatismele, patologia sânului, displazia cervicală sau cancerul cervical, obstrucţia intestinală.

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Dintre toate procedurile, intervenţiile abdominale au cel mai mare impact, fie că este vorba despre laparotomie sau laparoscopie. Există mai multe avantaje ale chirurgiei laparoscopice în timpul sarcinii: reducerea durerii, incizii mai mici, cicatrice mai mici, hernii incizionale reduse, recuperarea mai scurtă, timpul de spitalizare redus, reluarea precoce a funcţiei intestinale normale şi mobilizarea timpurie.

Există, de asemenea, posibile dezavantaje, cum ar fi rănirea uterului gravid, scăderea fluxului sanguin uterin mst papillomavirus homme traitement creşterea presiunii intraabdominale sau chiar absorbţia dioxidului de carbon de către mamă şi făt.

Datele din literatură în sprijinul laparo­scopiei sugerează că aceasta se poate face în siguranţă în timpul sarcinii.

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Among all procedures, abdominal interventions have the most important impact, either considering laparotomy, or laparoscopy. In the last years, laparoscopy seems to be the treatment of choice in gynecologic pathology during pregnancy, and there is evidence that supports that it is a safe procedure to perform during pregnacy 2, There are also possible some disadvantages, such as injuring the pregnant uterus, decreasing uterine blood flow by increased intraabdominal pressure or even carbon dioxide absorption by mother and fetus.

Laparoscopic gynecological procedures during pregnancy

Technique Because of the enlarged uterus, the placement of the trocars is important for a successful operation. The patient is placed in left side-down position. The access to the abdomen is made through an open technique. Usually, we use 5-mm laparoscopes for the sides and a mm laparoscope superior to the umbilicus.

Proceduri ginecologice laparoscopice în timpul sarcinii

In their study, Carter and Soper used 3-mm laparoscopes superior to the umbilicus on uteri that were at or above the umbilicus 7,8. Uterine manipulation must be minimal and intraperitoneal pressures must be kept below mm Hg 6,9.

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Tocolytic drugs are recommended to be used in case of uterine manipulation Imaging Ultrasounds. Ovarian cancer or pregnancy mass are usually discovered at routine ultrasound obstetrical examination.

Although there is no evidence of the specific use of these criteria in pregnant women, ultrasounds as an examination with high sensitivity and specificity is also very useful during pregnancy Kaijser et al. Magnetic resonance imaging. Magnetic Resonance Imaging MRI can be used when ultrasound examination is unclear and there is a high suspicion of malignancy.

Proceduri ginecologice laparoscopice în timpul sarcinii

Tumor markers. Physiological decidual and amnion cells produce CA, so the CA level is higher pregnancy.

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Still, CA level may help making the difference between benign and malignant tumors. AFP related to germ cell tumorsInhibine B and AMH related to granulosa cell tumors levels are higher in pregnacy and are used for follow-up 12, Adnexal torsion Ovarian torsion, also known as adnexal torsion or tubo-ovarian torsion, refers to an emergency condi­tion where the rotation of the ovary and portion of the fallopian tube on the supplying vascular pedicle can compromise the blood supply.

The result can be arterial, venous and lymphatic stasis, leading to ovarian and fallopian tube necrosis.

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Either intermittent, or sustained stasis, early diagnostic and laparoscopy are important in order to preserve the adnexa. Hypermobility of the ovary and adnexal mass are the two main reason of adnexal tor­sion Dermoid cysts and para ovarian cysts are frequently incriminated, and at most risk are masses between cm Adnexal torsion mainly occurs during the first trimester of pregnancy In pregnacy, adnexal torsion can occur as a complication of ovarian hyperstimulation syndrome 22, Shalev et al.

There is a common trend to consider laparoscopy the treatment of choice in adnexal torsion, being a safe procedure if special precautions are adhered to. Depending on the size of the cyst and the gestation age, aspiration, detorsion and subsequent cystectomy can be practiced.

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Adnexal mass The reported incidence of adnexal mass complicating pregnancy is about 0. Benign adnexal masses discovered during early pregnancy can be: functional cyst corpus luteum, follicular cyst, haemorrhagic cystdermoid cyst, serous cystadenoma, mucinous cystadenoma, endometrioma, leiomyomas, and paraovarian cyst Corpus luteum cysts and benign cystic teratomas has each one third 32, Cystic masses are conservative treated till the second trimester or even after delivery.

Depending on evolution of the cyst, measures must be taken. Often, there ovarian cancer or ovarian cancer or pregnancy a spontaneous resolution of functional cysts 34, If masses persist or grow larger, they must be removed in order to prevent torsion or rupture.

Non-functional cyst usually persists after 16 weeks of gestation 13,30,36, In cases where there is no need for surgical treatment during pregnancy, only survey is sufficient till delivery.

Otherwise, laparoscopic procedure should optimally be done between 16 and 20 weeks of gestation 27, Suspicious features like vascula­rized septa, solid components, papillae or nodules require further investigation through Magnetic Resonance Imaging and tumour markers analyzes Although ovarian cancer during pregnancy is rare, any sign of malignancy must be taken into consideration and appropriate treatment must be applied.

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The termination of pregnancy ovarian cancer or pregnancy indicated in early pregnancy, and chemotherapy can be safely used during second and third trimesters. Conclusions Gynecological disorders during pregnancy such as ovarian cysts and masses must first be thoroughly assessed by ultrasound examination and, if the situation ovarian cancer or pregnancy, by MRI examination, safely done during the second and the third trimesters.

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Also, CA level may be useful in distinguishing a benign from malignant disease. The moment of ovarian cancer or pregnancy is an important aspect. Small benign painless cysts should only be under surveillance as they may spontaneously remit, and large cysts or cysts that last over 16 weeks should be reassessed and undergo surgery.

When a pregnant patient has to undergo surgery, the obstetrician, the general surgeon, or the orthopedist, the neurosurgeon as appropriate, together with the anesthetist and the neonatologist must consult each other and take a decision.

ovarian cancer or pregnancy