RESUMEN
Gestational trophoblastic neoplasia (GTN) is a rare disease and is characterized by an abnormal proliferation of trophoblastic cells of placenta. Since majority of them are chemotherapy sensitive, they are one of the highly curable cancers. However, due to its varied presentation, clinicians still face many challenges in its diagnosis and management. We present a case of 26-year-old woman, P0 + 3 (previous 3 abortions) who presented to us with a history of vaginal bleeding postuterine evacuation after 2 months of incomplete abortion. After clinical, radiological assessment and high human chorionic gonadotropin (hCG) titers, the patient was diagnosed as a case of cervical GTN. Risk assessment by the WHO prognostic scoring system was done and "Low Risk" was assigned to her. She was given total nine cycles of single agent chemotherapy including two consolidation cycles after normalization of hCG titers which patient tolerated well and remained asymptomatic.
Asunto(s)
Enfermedad Trofoblástica Gestacional , Adulto , Gonadotropina Coriónica , Femenino , Enfermedad Trofoblástica Gestacional/diagnóstico , Enfermedad Trofoblástica Gestacional/tratamiento farmacológico , Humanos , Embarazo , Hemorragia UterinaRESUMEN
Preterm Prelabor rupture of membranes (PPROM) accompanies 2-3% of all pregnancies and 1/3rd of all preterm deliveries leading to intraamniotic infection, postpartum infections, sepsis along with perinatal morbidity and mortality worldwide. Early diagnosis and treatment can prevent the complications of PPROM and improve mother and child health. The platelet indices (platelet count, Mean platelet volume, Plateletcrit and Immature platelet fraction) could be a useful predictive parameters in PPROM, as platelets are acute phase reactants and there parameters may vary with inflammation and increased platelet consumption/production. In the present study, Mean Platelet volume (MPV) levels showed significant increase in cases as compared to controls (10.47 ± 1.92 fl Vs 8.84 ± 1.30 fl; P < 0.004). Plateletcrit (PCT) levels were also significantly increased in cases with respect to controls (0.22 ± 0.10% Vs 0.18 ± 0.05%; P = 0.004). Immature platelet fraction (IPF) is significantly increased in cases than in control subjects (8.73 ± 6.67% Vs 4.43 ± 1.75%; P < 0.001). Also, Mean Platelet volume (MPV) levels were found to be significantly higher in subjects whose neonate had developed sepsis(11.39 ± 1.69 fl Vs 8.91 ± 1.31 fl; P < 0.001) and respiratory distress (10.62 ± 2.09 fl Vs 9.26 ± 1.56 fl; P = 0.003). Similarly, PCT was significantly higher in groups with positive neonatal sepsis (0.32 ± 0.74% Vs 0.19 ± 0.65%; P = 0.010) and with respiratory distress (0.24 ± 0.78% Vs 0.18 ± 0.59%; P < 0.001). Levels of IPF were also increased in positive neonatal sepsis group (10.11 ± 6.27% Vs 5.06 ± 4.07%; P < 0.001) and respiratory distress group (9.11 ± 6.38% Vs 5.54 ± 4.43%; P = 0.009). The findings suggest that maternal platelet parameters (MPV, PCT and IPF) can be utilized as evidence of early predictors of development of neonatal sepsis and respiratory distress and may be considered as a predictive markers for adverse neonatal outcome.