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Updates in the Diagnosis of Gestational Trophoblast Disease

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

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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

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Development of Psychic Pain in the Context of Microcephaly and Abortion: Systematic Review and Meta-Analysis

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Health 2017年第2期9卷 376-391页

作者： Uilna Naté rcia Soares Feitosa Danilo Ferreira de Sousa Poliana Moreira de Medeiros Carvalho Raquel Guimarã es Kanda Joaquim Alves Diniz Luis Clescivan Ferreira Nobre Dayse Christina Rodrigues Pereira Luz Wilma José Santana Cí cera Jaqueline Sobreira Andriola Né lio Barreto Vieira Antonio Souto Gouveia Alberto Olavo Advincula Reis Caio Parente Barbosa Modesto Leite Rolim Neto Programa de Pó s-Graduaç ã o em Ciê ncias da Saú de Faculdade de Medicina do ABC-FMABC Santo Andr&eacute S&atilde o Paulo Brazil Faculdade de Juazeiro do Norte FJN Juazeiro do Norte Cear&aacute Brazil Faculdade de Medicina Est&aacute cio/fmj Juazeiro do Norte Cear&aacute Brazil Faculdade de Medicina Universidade Federal do Cariri-UFCA Barbalha Cear&aacute Brazil Programa de Pó s-Graduaç ã o em Saú de Pú blica Universidade de S&atilde o Paulo-USP S&atilde o Paulo Brazil

Background: In the year of 2015, evidence of a relation between Zika virus and the development of microcephaly in pregnant women who acquired the infection started to come up. Thus, it is extremely necessary that the analysis of the affliction affects these women in a biopsychosocial context, in order to discuss and comprehend in a more reliable manner the affection from the perception of the disease, origin, and psychic pain mechanisms. Methods: Systematic review with meta-analysis, using the PRISMA protocol. The study period was 2016 and the keywords included “microcephaly” and “abortion”, one at a time and then combined with the Boolean operator “AND.” The statistical analysis was done using the BioEstat 5.0 program. Calculation was based on an adjustment of Mantel-Haenszel random effect. Results: 41,046 registrations were found. Of this total, 40,992 articles were excluded because they only mentioned the fact or referred to spontaneous abortion, did not analyze abortion on the eyes of microcephaly, only treated with Zika virus, or were repeated. Limitations: Psychic pain and suffering need studies in the mother/son/disease relation, which were not found in the databases. The article was based on other sources. Conclusions: The pains vary in different areas of the female life, since internal conflicts, gender violence, stress, fear, insecurity, psychologic torture, grieve, loneliness, among other kinds of psychic suffering. More studies on psycho-emotional themes need to be promoted to discuss the female suffering on a wider vision, closer to the reality faced by these women.

关键词： Abortion Microcephaly Psychic Pain

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