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The Clinical Outcomes of In Vitro Fertilization/Intracytoplasmic Sperm Injection Treatments in 43 Women with a History of gestational trophoblastic disease

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Reproductive and Developmental Medicine 2018年第1期2卷 38-45页

作者： Xi Shen Yan-Ping Kuang Department of Reproductive Medicine Shanghai Ninth People’s Hospital Affiliated Shanghai Jiao Tong University School of MedicineShanghai 200011China Shanghai Ninth People’s Hospital Affiliated Shanghai JiaoTong University School of Clinical Medicine Shanghai 200011China

Background:To analyze the clinical outcomes of in vitro fertilization(IVF)/intracytoplasmic sperm injection treatments in women with a history of gestational trophoblastic disease(GTD).Methods:This retrospective study included 43 patients with a history of GTD as the study group and 43 matched patients as the control *** patients in the study group were divided into two groups according to the therapy *** in Subgroup A(n=32)underwent uterine curettage treatment *** in Subgroup B(n=11)underwent uterine curettage combined with *** characteristics of ovarian stimulation and outcomes of embryos and pregnancy were ***:In the first cycle,there was a higher number of retrieved oocytes and normal fertilized oocytes in the control group than those in the study group(9.2 vs.6.2 and 6.0 vs.4.0,respectively;P0.05).There was no difference in the outcomes between Subgroup A and Subgroup *** was a significant difference in thickness of the endometrium between the control group and study group(10.9 mm vs.9.2 mm,respectively;P<0.05).The biochemical pregnancy rate and ongoing pregnancy rate in the control group were significantly higher than those in the study group(51.4%vs.31.7%and 37.8%vs.18.3%,respectively;P<0.05).In the study group,28(93.3%)patients had intrauterine adhesion(IUA)and 23(76.7%)patients used an intrauterine device(IUD),which were both significantly higher than those in control group(P<0.05).In addition,the rate of IUA in second-look hysteroscopy was lower than that in the first surgery in the study group(P<0.05).Conclusions:Patients with a history of GTD can present with a similar normal fertilization rate and number of viable ***,patients with a history of GTD may have a thinner endometrium and lo

关键词： Chemotherapy gestational trophoblastic disease In Vitro Fertilization/Intracytoplasmic Sperm Injection Uterine Curettage Treatment

Management of gestational Trophoblast disease: A Review Integrative National and International Guidelines

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Health 2022年第12期14卷 1321-1333页

作者： Marcela Curvêllo Beltrão Maira de Lima Oliveira Mota Elizabeth Bacha Lusitania Maria de Barros Livia Helena Gomes de Barros Brandão Nelson Henriky Felix Mascarenhas Tallys Leandro Barbosa da Silva Maria Fernanda Telles Pires de Souza Séfora Maria Fragoso Braga Victoria de Oliveira Carmo Borges Centro Universitário Tiradentes (UNIT) Maceió Brasil Instituto de Medicina Integral Professor Fernando Figueira (IMIP) Pernambuco Brasil Estácio de Juazeiro do Norte (FMJ) Ceará Brasil Universidade Federal de Alagoas (UFAL) Maceió Brasil Sã o Leopoldo Mandic Campinas Brasil Hospital Regional de Arapiraca Arapiraca Brasil

GTD (gestational trophoblastic disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis and treatment of the aforementioned pathology results in inadequate risk classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to compare the different national and international guidelines in the management of GTD, through an integrative review. Nine articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized;in low-risk GTN (gestational trophoblastic Neoplasm): chemotherapy with methotrexate or actinomycin D, in high-risk: EMA/CO protocol, in ultra-high-risk EMA/PE, methotrexate with radiotherapy for brain metastases. All medical societies recommend the registration of these patients in GTD screening centers, endorse the use of the IFGO scoring system (2000) and recommend the surgical management of placental site trophoblastic or epithelioid tumors, as chemotherapy is less effective in these cases. The controversies are in the proper follow-up after the treatment of HM, use of ultrasound to evacuate the uterus, administration of anti-D immunoglobulin, time of oxytocin infusion and rescue regimens that can be used in cases of resistant or recurrent GTN. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of

关键词： Guidelines gestational trophoblastic disease Treatment

Invasive Mole of the Uterus: A Case Report

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Open Journal of Pathology 2022年第4期12卷 177-182页

作者： Herilalao Elisabeth Razafindrafara Zo Irène Raivoherivony Joëlle Razafimahefa Vahatra Nomeharisoa Rodrigue Emile Hasiniatsy Romuald Randriamahavonjy Nantenaina Soa Randrianjafisamindrakotroka Department of Pathology Joseph Ravoahangy Andrianavalona University Hospital Antananarivo Madagascar

Invasive mole is a rare subgroup of gestational trophoblastic disease characterized by the invasion of molar tissue into the myometrium or uterine vasculature. In this paper, we report the third case of invasive mole described in the Malagasy literature. A 33-year-old woman was referred to the Soavinandriana Hospital, her complaint was persistent vaginal bleeding during 2 months, occurring at 3 months of pregnancy with biological anemia without hemodynamic repercussions. The human chorionic gonadotropin (HCG) level was 385,931 mIU/ml. A haemostasis hysterectomy was performed. Histological examination showed an enlarged uterus and endometrial cavity containing edematous chorionic villi with trophoblastic proliferation invading the myometrium. The diagnosis was an invasive mole, stage I, FIGO score 6. Chemotherapy was prescribed but was not honored. After 45 days of follow-up, the serum βHCG level decreased to 1803 mIU/ml, without clinical symptoms. The patient then lost sight. Persistent vaginal bleeding after pregnancy may be the only clinical symptom of an invasive mole and should raise suspicion. Histological examination establishes the diagnosis. As this is an unusual cause of vaginal bleeding, our case should remind physicians that when faced with this symptom, the possibility of an invasive mole should be considered in order to make an early diagnosis for less aggressive treatment.

关键词： Hydatiform Mole gestational trophoblastic disease Invasive Mole Madagascar

Updates in the Diagnosis of gestational Trophoblast disease

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Health 2023年第1期15卷 48-58页

作者： Maira de Lima Oliveira Mota Marcela Curvêllo Beltrão Elizabeth Bacha Eduardo Fonseca Mascarenhas Filho Maísa Mendonça de Jesus Nelson Henriky Felix Mascarenhas Tallys Leandro Barbosa da Silva Maria Fernanda Telles Pires de Souza Victoria de Oliveira Carmo Borges Séfora Maria Fragoso Braga Centro Universitário Tiradentes (UNIT) Maceió Brasil Estácio de Juazeiro do Norte (FMJ) Ceará Brasil Universidade Federal de Alagoas (UFAL) Maceió Brasil Sã o Leopoldo Mandic Campinas Brasil Hospital Regional de Arapiraca Arapiraca Brasil

GTD (gestational trophoblastic disease) is a pathology that encompasses benign and malignant clinical forms, affects women of childbearing age, has a variable incidence and is more frequent in developing or underdeveloped countries, colliding with the economic barrier. The frequent absence of clear protocols and guidelines for the correct diagnosis of the pathology results in inadequate classification, imprecise treatment and failed post-therapeutic observation, increasing the risk of relapses, morbidity and mortality. The present study aims to point out updated national and international practice protocols of diagnosis of GTD, through an integrative review. Seven articles were selected and it was observed that the main international reference centers are agreed with the management suggested by the IFGO (International Federation of Gynecology and Obstetrics), being the conduct in the Hydatidiform Mole (HM): evacuation by suction and curettage under ultrasound guidance, followed by hCG monitoring every 1 - 2 weeks until normalized (usually one month for Partial Hydatidiform Mole six months for Complete Hydatidiform Mole and one year for gestational trophoblastic Neoplasia). Unfortunately, regarding the diagnosis of MH, the guidelines of some countries show the absence or difficulty of access to the karyotype test and ploid p57 or pelvic ultrasound accompanying the uterine curettage, contrary to what is proposed by the IFGO guideline. Establishing and complying with consistent guidelines can improve patient care, with early diagnosis of the pathology and its complications, reducing the rate of recurrence, morbidity and mortality, especially in less developed countries.

关键词： Diagnosis gestational trophoblastic disease Updates

gestational trophoblastic Neoplasia: Clinical and Therapeutic Profile in Madagascar

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Open Journal of Obstetrics and Gynecology 2020年第7期10卷 946-956页

作者： Norosoa Randriamaroson Malala Razakanaivo Ny Ony Andrianandrasana Zo Ambinintsoa Solofonirina Florine Rafaramino Radiotherapy Department University Hospital Joseph Ravoahangy Andrianavalona Antananarivo Madagascar Medical Oncology Department University Hospital Joseph Ravoahangy Andrianavalona Antananarivo Madagascar Faculty of Medicine Antananarivo Madagascar

gestational trophoblastic disease (GTD) develops from abnormal cellular proliferation of trophoblasts following fertilization. This includes complete and partial hydatidiform mole (HM) and gestational trophoblastic neoplasia (GTN). The aim of this study was to report the epidemiological, clinical and therapeutic profile of gestational trophoblastic neoplasia (GTN) over period of ten years in the department of Oncology Radiotherapy at the University Hospital Joseph Ravoahangy Andrianavalona (HJRA) Antananarivo Madagascar. Medical records of women diagnosed with GTD in the department of Oncology Radiotherapy at HJRA from January 1st, 2007 to September 2017 were retrospectively reviewed. Only patients with the FIGO diagnosis GTN were included, while those with the histological diagnosis of hydatidiform mole (HM), also sometimes classified as GTD, were not included in this study. Also excluded were all cases with incomplete or missing data. Twenty four patients were included. Median age of patients at the time of diagnosis was 37 years (range 18 - 60). Most patients developed GTN following molar pregnancy (75%), had disease duration from antecedent pregnancy of less than 6 months (58.20%), and had the pre-treatment hCG level more than 10,000 IU/L (58.27%). At diagnosis, 14 patients (58.33%) had localized disease (M0). Most common metastatic sites at initial diagnosis were the liver and brain (20.8

关键词： Choriocarcinoma gestational trophoblastic disease gestational trophoblastic Neoplasia Madagascar