Multidisciplinary Management of Labor in a Pregnant Woman with Metastatic Carcinoid Tumor History: A Case Report

A 32-year-old woman (G1, P0), ASA III, admitted for induction of labor at 39 weeks. Medical history of malignant ileocecal carcinoid tumor with hepatic, abdominal lymph node, and uterine metastasis 3 years ago, presenting with carcinoid syndrome. Since then, under medical therapy with monthly lanreotide. Pregnancy was uneventful. After multidisciplinary discussion, a protocol to be started during the labor, was developed. During induction of labor, signs of carcinoid syndrome were assessed hourly (wheezing, skin flushing, diarrhea, and blood pressure instability) and continuous intravenous infusion of octreotide, if any of these symptoms occurred, was to be initiated. For labor analgesia, a lumbar epidural block with non-histamine-releasing opioid drugs was performed without complications. Emphasis was placed on maintaining a normovolemic profile, avoiding sympathomimetic drugs for the treatment of hypotension. 

Although no signs suggestive of carcinoid syndrome were observed, this patient had a non-negligible risk for this syndrome, given her history. Therefore, a differentiated multidisciplinary plan was developed, outlining, at each moment, the measures to be implemented in the event of the appearance of characteristic signs and symptoms of carcinoid syndrome.