tailieunhanh - Critical Care Obstetrics part 73

Critical Care Obstetrics part 73 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Cancer in the Pregnant Patient can be closely observed 64 66 70 . Masses that persist into the second trimester particularly those that are rapidly enlarging larger than 8 cm and or appear complex and multiseptated most often require surgical exploration 64 . It has generally been advised that surgical exploration be undertaken at approximately 16-20 weeks gestation. This is a time when physiological cysts have regressed and the placenta is hormonally functional and the fetus is supported independent of the corpus luteum. If an oophorectomy which removes a functional corpus luteum is required during the first trimester the pregnancy should be supported with supplemental progesterone to prevent spontaneous abortion. If the mass is discovered in the third trimester definitive work- up management and surgical exploration can usually be deferred until after vaginal delivery or during cesarean section. The various options available for the surgical approach must also be considered. Traditionally patients in these clinical situations have undergone open laparotomy. More recently with technologic advances more surgical options are now available for use in the pregnant patient. The use of minimally invasive techniques including robotic surgery has been shown to be generally safe and effective. In any surgical approach the gravid uterus should be manipulated as little as possible to minimize any potential risk of spontaneous preterm labor rupture of membranes or any other potential complication that may lead to fetal loss. If the mass is benign unilateral cystectomy is performed whenever possible and the contralateral ovary should then be inspected to ensure normal appearance. While most masses in pregnancy are confined to a single ovary it is not uncommon to find bilateral involvement. There are currently insufficient data to determine the optimal management of patients who require surgery during pregnancy. These decisions should be made on a case-by-case basis in .