RESUMO
Introducción: La enfermedad trofoblástica gestacional (ETG) corresponde al espectro de lesiones proliferativas del tejido trofoblástico placentario. Presenta una incidencia mundial variable; en Chile no existen estudios nacionales, por lo que las cifras se deben extrapolar de estudios extranjeros. Objetivo: Caracterizar clínica y epidemiológicamente a las pacientes diagnosticadas con embarazo molar en el periodo 2013-2022 en el Hospital Regional de Talca (HRT). Método: Estudio observacional transversal, se consideró el recuento total de pacientes de la base de datos del Servicio de Onco-Ginecología (n = 100) y la cantidad de embarazos ocurridos entre 2013-2022 en el HRT. Resultados: La edad promedio de presentación fue de 32 años, obteniéndose una incidencia de ETG de 2,1 casos por cada 1.000 embarazos. El 54% de los casos corresponde a mola parcial. Los principales síntomas fueron metrorragia (67%) y dolor abdominal (40%). El principal tratamiento efectuado fue aspiración uterina (92%). En el 48% de los casos se sospechó la ETG con la clínica previo al diagnóstico por biopsia y solo en un 13% únicamente con estudio ecográfico. Conclusiones: Es necesario realizar más investigaciones nacionales que permitan recopilar información actualizada sobre ETG, sobre todo por la variabilidad clínica de la enfermedad, que hace difícil su sospecha diagnóstica.
Introduction: Gestational trophoblastic disease (GTO) corresponds to the spectrum of proliferative lesions of placental trophoblastic tissue. It has a variable global incidence; in Chile there are no national studies so it must be extrapolated from foreign studies. Objective: To clinically and epidemiologically characterize patients diagnosed with molar pregnancy in the period 2013-2022, at the Talca Regional Hospital (HRT). Method: Cross-sectional observational study, the total count of patients from the Onco-Gynecology Service database (n = 100) and the number of pregnancies that occurred between 2013-2022 in the HRT were considered. Results: The average age of presentation was 32 years, obtaining an incidence of GTO of 2.1 cases per 1000 pregnancies; 54% of cases correspond to partial mole. The main symptoms were metrorrhagia (67%) and abdominal pain (40%). The main treatment performed was uterine aspiration (92%). In 48% of the cases, GTO was suspected with clinical symptoms prior to diagnosis by biopsy, and only 13% with an ultrasound study alone. Conclusions: It is necessary to carry out more national research to collect updated information on GTO, especially due to the clinical variability of the disease that makes its diagnostic suspicion difficult.
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Doença Trofoblástica Gestacional/epidemiologia , Coriocarcinoma/epidemiologia , Mola Hidatiforme/epidemiologia , Chile , Estudos Transversais , Doença Trofoblástica Gestacional/diagnóstico , Hospitais PúblicosRESUMO
OBJECTIVE: To assess whether the incidence and aggressiveness of molar pregnancy (MP) and postmolar gestational trophoblastic neoplasia (GTN) changed during the COVID-19 pandemic. DESIGN: Observational study with two separate designs: retrospective multicentre cohort of patients with MP/postmolar GTN and a cross-sectional analysis, with application of a questionnaire. SETTING: Six Brazilian Reference Centres on gestational trophoblastic disease. POPULATION: 2662 patients with MP/postmolar GTN treated from March-December/2015-2020 were retrospectively evaluated and 528 of these patients answered a questionnaire. METHODS: Longitudinal retrospective multicentre study of patients diagnosed with MP/ postmolar GTN at presentation and a cross-sectional analysis, with application of a questionnaire, exclusive to patients treated during the period of study, to assess living and health conditions during the COVID-19 pandemic compared with previous years. MAIN OUTCOME MEASURES: The incidence of MP/postmolar GTN. RESULTS: Compared with the last 5 pre-pandemic years, MP/postmolar GTN incidence remained stable during 2020 (COVID-19 pandemic). Multivariable logistic regression, adjusted for the patient age, showed that during 2020, presentation with MP was more likely to be >10 weeks of gestation (adjusted odds ratio [aOR] 2.50, 95% confidence interval [CI] 1.90-3.29, P < 0.001), have a pre-evacuation hCG level ≥100 000 iu/l (aOR 1.77, 95% CI 1.38-2.28, P < 0.001) and time to the initiation of chemotherapy ≥7 months (aOR 1.86, 95% CI 1.01-3.43, P = 0.047) when compared with 2015-2019. CONCLUSIONS: Although the incidence of MP/postmolar GTN remained stable during the COVID-19 pandemic in Brazil, the pandemic was associated with greater gestational age at MP diagnosis and more protracted delays in initiation of chemotherapy for postmolar GTN.
Assuntos
COVID-19 , Doença Trofoblástica Gestacional , Mola Hidatiforme , Gravidez , Feminino , Humanos , Pandemias , Estudos Retrospectivos , Estudos Transversais , COVID-19/epidemiologia , Mola Hidatiforme/epidemiologia , Mola Hidatiforme/terapia , Doença Trofoblástica Gestacional/epidemiologia , Gonadotropina CoriônicaRESUMO
BACKGROUND: Telemonitoring is an alternative to in-person appointments and overcomes geographic distance barriers. OBJECTIVE: The primary objective of this study was to evaluate adherence to post-molar follow-up using both WhatsApp and in-person appointments compared with standard care. The secondary objective was to evaluate the rate of completion of post-molar follow-up of complete moles, considering 6 and 3 months of duration. METHODS: This retrospective cohort study was conducted at the Gestational Trophoblastic Disease Center, São Paulo Hospital. Patients with complete or partial mole treatment between January 1, 2009 and December 31, 2018 were included in two groups: group 1 (patients from 2009 to 2013) and group 2 (from 2014 to 2018), before and after telemonitoring implementation, respectively. Complete follow-up was considered if after the first normal human chorionic gonadotropin (hCG) level (<5 mIU/mL), the patient was followed up for an additional 30 days (partial mole) or 180 days (complete mole). Loss to post-molar follow-up with positive hCG was also evaluated. Statistical analysis was performed using Pearson's Χ2 test, 5% significance level (p=0.05), and R version 4.0.2. RESULTS: A total of 308 patients were included in the study, 92 of them were assessed in group 1 and 216 patients in group 2. There was no difference between the rates of complete follow-up after telemonitoring implementation (complete mole: 42/72=58.3% group 1 vs 85/163=52.1% group 2; p=0.38; partial mole: 16/20=80% group 1 vs 37/53=69.8 group 2; p=0.3), and no increase of loss to post-molar follow-up with positive hCG (8/92=8.7% group 1 vs 14/216=6.5% group 2; p=0.49). The shortening of follow-up of complete moles to 90 days increased the rate of complete post-molar follow-up (from 127/235=54.0% to 189/235=80.4%, p<0.001). CONCLUSIONS: The association of telemonitoring with in-person appointments could have had an advantage in post-molar follow-up since it did not reduce adherence to hormonal surveillance. Shortening post-molar follow-up after complete mole to 90 days after the first normal hCG level increased the rate of complete post-molar follow-up.
Assuntos
Mola Hidatiforme , Telemedicina , Neoplasias Uterinas , Brasil , Gonadotropina Coriônica , Feminino , Humanos , Mola Hidatiforme/epidemiologia , Gravidez , Estudos Retrospectivos , Neoplasias Uterinas/terapiaRESUMO
La enfermedad trofoblástica gestacional (ETG) constituye un conjunto heterogéneo de afecciones malignas y benignas derivados de la proliferación anormal del trofoblasto o de las células germinales de ambos sexos. La ETG tiene una incidencia variable a lo largo del mundo. A nivel nacional, no se han realizado estudios de caracterización epidemiológica de esta población y, frecuentemente, los datos manejados están basados en estudios extranjeros. Objetivo: Determinar las características clínicas y epidemiológicas de las pacientes diagnosticadas con embarazo molar en el período transcurrido entre el año 2012 y 2019, en el hospital Clínico Herminda Martin de Chillán. Materiales y métodos: Estudio observacional transversal de serie temporal, se consideró el número total de fichas clínicas del Hospital Clínico Herminda Martin de Chillán durante los años 2012 al 2019, con diagnóstico confirmado de Embarazo Molar. Los datos se registraron en la hoja de recolección de datos elaborada, realizándose los análisis estadísticos pertinentes. Resultados: Se analizaron 44 pacientes, la edad promedio de presentación fue de 30.96 años. Los principales síntomas de consulta fueron metrorragia 52.27% (n=23) y dolor abdominal 20.45% (n=9). El principal tratamiento efectuado fue aspiración y legrado en un 77,27% (n=34). El 4.54% (n=2) presentó recurrencia, presentando un segundo episodio de embarazo molar. Conclusiones: El embarazo molar es una patología poco frecuente, pero es un diagnóstico diferencial a tener en cuenta, sobre todo cuando nos enfrentamos a mujeres en edad fértil que consultan por metrorragia o dolor abdominal.
Gestational trophoblastic disease (GTS) is a heterogeneous group of malignant and benign conditions derived from abnormal proliferation of the trophoblast or germ cells of both sexes. GTS has a variable incidence throughout the world. Nationally, no epidemiological characterization studies have been carried out for this population and, frequently, the data handled is based on foreign studies. Objective: To determine the clinical and epidemiological characteristics of patients diagnosed with molar pregnancy between the period between 2012 and 2019 at the Hospital Clinico Herminda Martin of Chillan. Materials and methods: Retrospective observational descriptive cross-sectional study, considering the pregnancies registered at the Hospital Clinico Herminda Martin of Chillan during the years 2012 to 2019, with a confirmed diagnosis of Molar Pregnancy, as sample of study. The data were recorded on the prepared data collection sheet, performing the relevant statistical analyzes. Results: 44 patients were analyzed, the average age of presentation was 30.96 years. The main symptoms of consultation were metrorrhagia 52.27% (n = 23) and abdominal pain 20.45% (n = 9). The main treatment was aspiration and curettage in 77.27% (n = 34). 4.54% (n = 2) presented recurrence, presenting a second episode of molar pregnancy. Conclusions: Molar pregnancy is a rare pathology, but it is a differential diagnosis to take into account, especially when we are faced with women of childbearing age who consult due to bleeding or abdominal pain.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Mola Hidatiforme/diagnóstico , Doença Trofoblástica Gestacional , Mola Hidatiforme/epidemiologia , Dor Abdominal , Chile/epidemiologia , Diagnóstico Diferencial , Estudo Observacional , MetrorragiaRESUMO
OBJECTIVE: To determine the clinical characteristics of multiple gestation with complete mole and coexisting fetus (CHMCF) in North and South America. METHODS: Retrospective non-concurrent cohorts compromised of CHMCF from New England Trophoblastic Disease Center (NETDC) (1966-2015) and four Brazilian Trophoblastic Disease Centers (BTDC) (1990-2015). RESULTS: From a total of 12,455 cases of gestational trophoblastic disease seen, 72 CHMCF were identified. Clinical characteristics were similar between BTDC (n=46) and NETDC (n=13) from 1990 to 2015, apart from a much higher frequency of potentially life-threatening conditions in Brazil (p=0.046). There were no significant changes in the clinical presentation or outcomes over the past 5 decades in NETDC (13 cases in 1966-1989 vs 13 cases in 1990-2015). Ten pregnancies were electively terminated and 35 cases resulted in viable live births (60% of 60 continued pregnancies). The overall rate of gestational trophoblastic neoplasia (GTN) was 46%; the cases which progressed to GTN presented with higher chorionic gonadotropin levels (p=0.026) and higher frequency of termination of pregnancy due to medical complications (p=0.006) when compared to those with spontaneous remission. CONCLUSIONS: The main regional difference in CHMCF presentation is related to a higher rate of potentially life-threatening conditions in South America. Sixty percent of the expectantly managed CHMCF delivered a viable infant, and the overall rate of GTN in this study was 46%. Elective termination of pregnancy did not influence the risk for GTN; however the need for termination due to complications and higher hCG levels were associated with development of GTN in CHMCF.
Assuntos
Aborto Induzido/estatística & dados numéricos , Mola Hidatiforme/epidemiologia , Complicações Neoplásicas na Gravidez/epidemiologia , Gravidez de Gêmeos , Neoplasias Uterinas/epidemiologia , Aborto Espontâneo/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Gonadotropina Coriônica/sangue , Estudos de Coortes , Feminino , Morte Fetal , Humanos , Mola Hidatiforme/sangue , Hipertireoidismo/epidemiologia , Nascido Vivo/epidemiologia , New England/epidemiologia , América do Norte , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações Neoplásicas na Gravidez/sangue , Gravidez Múltipla , Nascimento Prematuro/epidemiologia , Síndrome do Desconforto Respiratório/epidemiologia , Estudos Retrospectivos , América do Sul , Hemorragia Uterina/epidemiologia , Neoplasias Uterinas/sangue , Adulto JovemRESUMO
OBJECTIVES: To compare complete hydatidiform mole (CHM) clinical presentation and risk factors associated with GTN development between North American and South American adolescents. METHODS: This non-concurrent cohort study was undertaken including adolescents with CHM referred to centers in North America (New England Trophoblastic Disease Center, Harvard University, USA), and South America (Botucatu Trophoblastic Disease Center-São Paulo State University, Brazil; Trophoblastic Unit of Central University of Venezuela and Maternidad Concepcion Palacios of Caracas, Venezuela) between 1990 and 2012. Data were obtained from medical records and pathology reports. Study participants were allocated into 2 groups: North America (NA) and South America (SA). RESULTS: In NA and SA, 13.1% and 30.9% of patients with hydatidiform mole were adolescents, respectively. Of these, 77.6% in NA and 86.1% in SA had pathologic diagnosis of CHM (p=0.121). Vaginal bleeding (SA=69% vs NA=51%; p=0.020), anemia (SA=48% vs NA=18%; p<0.001), and elevated serum hCG (SA=232,860mIU/mL vs NA=136,412mIU/mL; p=0.039) were more frequent in SA than in NA. Median gestational age at diagnosis (SA=12weeks, NA=11weeks; p=0.030) differed whereas GTN development rate (SA=20%, NA=27%; p=0.282) showed no significant difference between groups. Compared to NA, medical complications and clinical factors associated with post-molar GTN were more frequent among SA adolescents. CONCLUSIONS: Medical complications and clinical factors associated with GTN development were more frequent in SA than in NA adolescents with CHM, suggesting that, in South America, awareness about the importance of diagnosing molar pregnancy early and considering CHM in the differential diagnosis in adolescents suspected to be pregnant should be raised.
Assuntos
Doença Trofoblástica Gestacional/epidemiologia , Mola Hidatiforme/epidemiologia , Adolescente , Adulto , Fatores Etários , Criança , Estudos de Coortes , Feminino , Humanos , América do Norte , Gravidez , Estudos Retrospectivos , América do Sul , Adulto JovemRESUMO
OBJECTIVE: The aim of the study was to evaluate potential changes in the clinical, diagnostic, and therapeutic parameters of complete hydatidiform mole in the last 25 years in Brazil. METHODS: A retrospective cohort study was conducted involving the analysis of 2163 medical records of patients diagnosed with complete hydatidiform mole who received treatment at the Rio de Janeiro Reference Center for Gestational Trophoblastic Disease between January 1988 and December 2012. For the statistical analysis of the natural history of the patients with complete molar pregnancies, time series were evaluated using the Cox-Stuart test and adjusted by linear regression models. RESULTS: A downward linear temporal trend was observed for gestational age of complete hydatidiform mole at diagnosis, which is also reflected in the reduced occurrence of vaginal bleeding, hyperemesis and pre-eclampsia. We also observed an increase in the use of uterine vacuum aspiration to treat molar pregnancy. Although the duration of postmolar follow-up was found to decline, this was not accompanied by any alteration in the time to remission of the disease or its progression to gestational trophoblastic neoplasia. CONCLUSIONS: Early diagnosis of complete hydatidiform mole has altered the natural history of molar pregnancy, especially with a reduction in classical clinical symptoms. However, early diagnosis has not resulted in a reduction in the development of gestational trophoblastic neoplasia, a dilemma that still challenges professionals working with gestational trophoblastic disease.
Assuntos
Mola Hidatiforme/diagnóstico , Mola Hidatiforme/terapia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Estudos de Coortes , Feminino , Humanos , Mola Hidatiforme/epidemiologia , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Adulto JovemRESUMO
OBJECTIVE: To compare the clinical presentation and incidence of postmolar gestational trophoblastic neoplasia (GTN) among recent (1994-2013) and historical (1988-1993) cases of complete hydatidiform mole (CHM). METHODS: This study included two non-concurrent cohorts (1988-1993 versus 1994-2013) of patients from the New England Trophoblastic Disease Center (NETDC). Clinical and pathologic reports of patients diagnosed with CHM between 1994 and 2013 were reviewed. Gestational age at evacuation, features of clinical presentation, human chorionic gonadotropin (hCG) levels, and the rate of progression to GTN were compared. RESULTS: In the current cohort (1994 to 2013) the median gestational age at diagnosis continued to decline compared to our prior cohort (1988-1993) (9weeks versus 12weeks). Patients from the current cohort were significantly more likely to be diagnosed prior to the 11th week of gestation (56 versus 41%, p=0.04). Patients in the current cohort were also significantly less likely to present with vaginal bleeding (46 versus 84%, p<0.001). Earlier diagnosis of complete mole did not result in a decrease in the rate of postmolar GTN. The frequencies of postmolar GTN in the current (1994-2013) and prior (1988-1993) cohorts were 19 and 23%, respectively. In the current cohort, even diagnosis prior to ten weeks gestation did not decrease the risk of developing GTN. CONCLUSIONS: This study indicates that complete mole continues to be diagnosed progressively earlier resulting in a further decrease in some classical presenting symptoms. However, despite earlier detection, the risk of development of postmolar GTN has not been affected.
Assuntos
Doença Trofoblástica Gestacional/patologia , Mola Hidatiforme/diagnóstico , Adulto , Estudos de Coortes , Detecção Precoce de Câncer , Feminino , Doença Trofoblástica Gestacional/epidemiologia , Humanos , Mola Hidatiforme/epidemiologia , Mola Hidatiforme/patologia , Incidência , New England/epidemiologia , Gravidez , Sistema de Registros , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVE: To evaluate treatment of Brazilian patients with gestational trophoblastic disease (GTD). STUDY DESIGN: A retrospective cohort study with analysis of medical reports performed in 10 Brazilian referral centers from January 2000 to December 2011. RESULTS: Of 5,250 patients 3 died (0.06%) at the time of uterine evacuation. Spontaneous remission of GTD (group G1) was observed in 4,103 cases, and 1,144 (21.8%) progressed to gestational trophoblastic neoplasia (GTN) (G2). In G1 2,716 (66.2%) had complete hydatidiform mole (HM) and 1,210, partial HM (29.5%); 3,772 patients (92.7%) recovered as noted in December 2012. In G2, of 1,118 patients treated, initial histopathological results of previous gestation were complete HM (77.5% [n = 886]), partial HM (8.8% [n = 100]), and choriocarcinoma (8.0% [n = 92]); 930 (81.3%) were low-risk, 200 (17.5%) were high-risk GTN, and 14 had placental site trophoblastic tumor (PSTT) (1.2%); cure was achieved in 1,078 cases (96.4%), but 26 patients (2.3%) died (4 low-risk [0.4%], 19 high-risk [9.5%], and 3 PSTT [21.4%]). CONCLUSION: The highest death rates were due to high-risk GTN and PSTT. Patients with molar pregnancy should be referred to a referral center for an early diagnosis and prompt treatment of GTN in order to reduce the morbidity and mortality found in advanced stages.
Assuntos
Doença Trofoblástica Gestacional/epidemiologia , Doença Trofoblástica Gestacional/terapia , Brasil/epidemiologia , Coriocarcinoma/epidemiologia , Coriocarcinoma/terapia , Estudos de Coortes , Consenso , Feminino , Doença Trofoblástica Gestacional/patologia , Humanos , Mola Hidatiforme/epidemiologia , Mola Hidatiforme/terapia , Estadiamento de Neoplasias , Gravidez , Remissão Espontânea , Estudos Retrospectivos , Fatores de Risco , Tumor Trofoblástico de Localização Placentária/epidemiologia , Tumor Trofoblástico de Localização Placentária/terapia , Neoplasias Uterinas/epidemiologia , Neoplasias Uterinas/terapiaRESUMO
There is a wide variation in reported incidence, risk factors and presentation of molar pregnancy. This necessitates population-based studies to determine these parameters at the University Hospital of the West Indies, which is a referral centre for these conditions. The incidence of molar pregnancy at the University Hospital of the West Indies was found to be 2.81 per 1,000, which fell in the range of worldwide values. Partial moles made up 61.1% and complete moles 31.0%. The mean age of the patients was 28.49 years old with 85% of patients aged between 20 and 40 years old. The median gestational age by dates was 12 weeks and vaginal bleeding was the most common presenting symptom (77%). A significant number of cases (52.2%) of molar pregnancy were diagnosed by routine histopathology for failed pregnancy and not by pre-evacuation ultrasound. The practice of routine assessment of tissue from failed pregnancy should therefore be encouraged in our population.
Assuntos
Mola Hidatiforme/epidemiologia , Neoplasias Uterinas/epidemiologia , Adolescente , Adulto , Gonadotropina Coriônica Humana Subunidade beta/sangue , Feminino , Idade Gestacional , Hospitais Universitários , Humanos , Mola Hidatiforme/complicações , Mola Hidatiforme/diagnóstico , Incidência , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Hemorragia Uterina/etiologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico , Índias Ocidentais/epidemiologia , Adulto JovemRESUMO
PURPOSE: To determine the frequency of hydatiform mole in tissues obtained by curettage. METHODS: A cross-sectional, prospective and descriptive conducted on patients who underwent curretage due to a diagnosis of abortion or hydatiform mole whose material was sent for pathological examination. We excluded women who did not accept to participate and refused to sign the free informed consent form. We studied the following variables: pathological findings, age, race, number of pregnancies and previous abortions, gestational age at diagnosis, quantitative serum beta fraction of human chorionic gonadotropin and ultrasound findings. The data were compared to the to histological diagnosis, considered to be the gold standard. Data were stored and analyzed in Microsoft Excel(®) software and the Epi-Info program, version 6.0 (STATCALC) and the results are presented as frequency (percentage) or mean±standard deviation. The χ(2) test was used to determine the association between qualitative variables and the level of significance was set at p<0.005. RESULTS: A total of 515 curettage procedures were performed, 446 of which comprised the sample. The frequency of hydatiform mole was 2.2% (ten cases). The mean age of the patients with a mole was 31±10 years, most patients were white and multiparous and had no history of previous abortions, but there was no significant association between these variables. The pregnancy loss occurred early in patients with and without a mole and the most common complaints in both groups were vaginal bleeding and cramps in the lower abdomen. Quantitative determination of human chorionic gonadotropin was performed in 422 cases (413 with and 9 without a hydatiform mole). The levels of the hormone were higher than 100,000 mIU/mL in 1.9% of the patients without a hydatiform mole and in 44.45% of the patients with the disease (p=0.00004). All patients with this hormonal level had an ultrasound suspicion of hydatiform mole and one of them also had a clinical suspicion. A total of 333 patients underwent ultrasound examination. Of the patients with sonographic findings suggestive of molar pregnancy, there was confirmation in five (41.7%) cases. The other seven (58.3%) were false positives. A significant association was found between ultrasound suspected molar pregnancy and disease confirmation by histopathological analysis (p=0.0001). In 50% of cases of hydatiform mole there was no suspicion of the disease according to clinical signs and symptoms, levels of beta fraction of human chorionic gonadotropin or sonographic findings. CONCLUSIONS: The frequency of hydatidiform mole is low and the disease may not be suspected by clinical examination, ultrasonography or the serum level of the beta fraction of human chorionic gonadotropin, requiring pathological examination of tissue obtained by uterine evacuation for diagnosis.
Assuntos
Curetagem , Mola Hidatiforme/epidemiologia , Mola Hidatiforme/cirurgia , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Estudos Prospectivos , Adulto JovemRESUMO
OBJETIVO: Determinar a frequência de mola hidatiforme em tecidos obtidos por curetagem uterina. MÉTODOS: Estudo transversal, prospectivo e descritivo que incluiu pacientes submetidas à curetagem uterina por diagnóstico de aborto ou mola hidatiforme cujo material obtido foi encaminhado para exame anatomopatológico. Foram excluídas aquelas que não aceitaram participar da pesquisa, recusando-se a assinar o Termo de Consentimento Informado Livre e Esclarecido. Foram analisadas as seguintes variáveis: achados anatomopatológicos, idade, raça/cor, número de gestações e abortos prévios, idade gestacional no momento do diagnóstico, níveis séricos quantitativos da fração beta da gonadotrofina coriônica humana e achados ultrassonográficos. As variáveis foram empregadas para a verificação com o diagnóstico histológico, considerado o padrão-ouro. Os dados foram armazenados e analisados no software Microsoft Excel® e no programa Epi-Info, versão 6.0 (STATCALC) e os resultados apresentados como frequência (porcentagem) ou média±desvio padrão. Para a associação entre variáveis qualitativas foi usado o teste do χ², e admitiu-se significância estatística quando p<0,05. RESULTADOS: No período, foram realizadas 515 curetagens, das quais 446 compuseram a amostra. A frequência de mola hidatiforme foi de 2,2% (dez casos). A média de idade das pacientes com mola foi 31±10 anos, a maioria era da raça branca e multípara e não tinha antecedente de aborto prévio, mas não houve associação significativa entre essas variáveis. A perda gestacional foi precoce nas pacientes com e sem mola, e as queixas mais comuns em ambos os grupos foram: sangramento vaginal e dor em cólica em hipogástrio. A dosagem sérica quantitativa da fração beta da gonadotrofina coriônica humana foi obtida em 422 casos (413 sem mola hidatiforme e 9 com mola hidatiforme). Os níveis do hormônio foram superiores a 100.000 mUI/mL em 1,9% das pacientes sem mola hidatiforme, e em 44,45% das pacientes com a doença (p=0,00004). Todas as pacientes com esse nível de hormônio tinham suspeita ultrassonográfica de gestação molar e uma delas apresentava também suspeita clínica. Trezentas e trinta e três pacientes foram submetidas a exame ultrassonográfico. Das pacientes com achados ultrassonográficos sugestivos de gestação molar, houve confirmação diagnóstica em cinco (41,7%) casos. Os outros sete (58,3%) eram falso-positivos. Houve associação significativa entre achado ultrassonográfico suspeito de gestação molar e confirmação da doença pela análise anatomopatológica (p=0,0001). Em metade dos casos de mola hidatiforme não havia suspeita da doença pelo quadro clínico, níveis da fração beta da gonadotrofina coriônica humana ou achados ultrassonográficos. CONCLUSÕES: A frequência de mola hidatiforme é baixa e a doença pode não ser suspeitada pelo quadro clínico, pela ultrassonografia e pelo nível sérico da fração beta da gonadotrofina coriônica humana, exigindo análise anatomopatológica dos tecidos obtidos pelo esvaziamento uterino para o seu diagnóstico.
PURPOSE: To determine the frequency of hydatiform mole in tissues obtained by curettage. METHODS: A cross-sectional, prospective and descriptive conducted on patients who underwent curretage due to a diagnosis of abortion or hydatiform mole whose material was sent for pathological examination. We excluded women who did not accept to participate and refused to sign the free informed consent form. We studied the following variables: pathological findings, age, race, number of pregnancies and previous abortions, gestational age at diagnosis, quantitative serum beta fraction of human chorionic gonadotropin and ultrasound findings. The data were compared to the to histological diagnosis, considered to be the gold standard. Data were stored and analyzed in Microsoft Excel® software and the Epi-Info program, version 6.0 (STATCALC) and the results are presented as frequency (percentage) or mean±standard deviation. The χ2 test was used to determine the association between qualitative variables and the level of significance was set at p<0.005. RESULTS: A total of 515 curettage procedures were performed, 446 of which comprised the sample. The frequency of hydatiform mole was 2.2% (ten cases). The mean age of the patients with a mole was 31±10 years, most patients were white and multiparous and had no history of previous abortions, but there was no significant association between these variables. The pregnancy loss occurred early in patients with and without a mole and the most common complaints in both groups were vaginal bleeding and cramps in the lower abdomen. Quantitative determination of human chorionic gonadotropin was performed in 422 cases (413 with and 9 without a hydatiform mole). The levels of the hormone were higher than 100,000 mIU/mL in 1.9% of the patients without a hydatiform mole and in 44.45% of the patients with the disease (p=0.00004). All patients with this hormonal level had an ultrasound suspicion of hydatiform mole and one of them also had a clinical suspicion. A total of 333 patients underwent ultrasound examination. Of the patients with sonographic findings suggestive of molar pregnancy, there was confirmation in five (41.7%) cases. The other seven (58.3%) were false positives. A significant association was found between ultrasound suspected molar pregnancy and disease confirmation by histopathological analysis (p=0.0001). In 50% of cases of hydatiform mole there was no suspicion of the disease according to clinical signs and symptoms, levels of beta fraction of human chorionic gonadotropin or sonographic findings. CONCLUSIONS: The frequency of hydatidiform mole is low and the disease may not be suspected by clinical examination, ultrasonography or the serum level of the beta fraction of human chorionic gonadotropin, requiring pathological examination of tissue obtained by uterine evacuation for diagnosis.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Adulto Jovem , Curetagem , Mola Hidatiforme/epidemiologia , Mola Hidatiforme/cirurgia , Estudos Transversais , Estudos ProspectivosRESUMO
OBJECTIVE: To give an overview of gestational trophoblastic disease in a referral center in Rio de Janeiro, Brazil. STUDY DESIGN: From January 1960 to December 2008, 4,290 registered patients were followed at the Gestational Trophoblastic Neoplasia Referral Center of Rio de Janeiro. All cases of complete and partial moles and of gestational trophoblastic neoplasia (GTN) were included and analyzed. Diagnosis, uterine evacuation, follow-up, chemotherapy and hysterectomy were reviewed in all patients. RESULTS: The historical progression of molar pregnancy to GTN was 19.1%, decreasing to 11.6% in the last 9 years. The overall survival rate was 92.5% in patients with GTN. CONCLUSION: Despite the intensive activities of the several Brazilian Referral Centers, governmental authorities do not consider gestational trophoblastic disease relevant and do not support any programs in its management. Official health data still omit vital statistics information on gestational trophoblastic disease.
Assuntos
Mola Hidatiforme/epidemiologia , Neoplasias Uterinas/epidemiologia , Brasil/epidemiologia , Terapia Combinada/estatística & dados numéricos , Feminino , Humanos , Mola Hidatiforme/tratamento farmacológico , Mola Hidatiforme/cirurgia , Incidência , Gravidez , Prevalência , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Neoplasias Uterinas/tratamento farmacológico , Neoplasias Uterinas/cirurgiaRESUMO
OBJECTIVE: To analyze the clinical trends of gestational trophoblastic neoplasia (GTN) at the Department of Obstetrics and Gynecology, Hospital Universitario de Caracas (HUC). STUDY DESIGN: A medical record review was performed of epidemiologic, clinical and diagnostic features of 25 cases of GTN at HUC from 1997 to 2004. RESULTS: During the study period, 35,300 deliveries occurred, and 25 patients were diagnosed with GTN; the prevalence was 0.70:1,000 deliveries. The mean age was 29.2 years. Fifty-six percent were posthydatidiform mole (HM), 36% postchoriocarcinoma (CC), 4% postinvasive mole and 4% postabortion with abundant intermediate trophoblast. Vaginal bleeding was the main symptom in patients with CC. Two cases resembled ectopic pregnancy, and another resembled a vaginal endometrioma. Fifty-two percent of cases were at stage Ib; 76% received single-agent chemotherapy. Hysterectomy was performed in 6 cases. Twenty-one patients achieved remission, 2 showed regression and 2 died. CONCLUSION: GTN had a high prevalence because HUC is a reference center. The most common presentation was post-HM GTN. Vaginal bleeding is frequent in CC and can mimic other gynecologic diseases. Chemotherapy is helpful, and hysterectomy can be performed in selected cases at early stages or with severe vaginal bleed-with a good ing. GTN has a good prognosis, and early diagnosis is possible.
Assuntos
Coriocarcinoma/epidemiologia , Doença Trofoblástica Gestacional/epidemiologia , Mola Hidatiforme/epidemiologia , Adulto , Coriocarcinoma/complicações , Gonadotropina Coriônica/sangue , Feminino , Doença Trofoblástica Gestacional/terapia , Hemorragia/etiologia , Humanos , Mola Hidatiforme/complicações , Pessoa de Meia-Idade , Gravidez , Prevalência , Prognóstico , Estudos Retrospectivos , Neoplasias Uterinas/complicações , Neoplasias Uterinas/epidemiologia , Doenças Vaginais/etiologia , Venezuela/epidemiologiaRESUMO
Objetivo: Analizar los hallazgos clínicos y el seguimiento de los casos de neoplasia trofoblástica gestacional. Material y Métodos: Se revisaron todos los casos de mola hidatidiforme en el Hospital Félix Bulnes Cerda, entre los años 1992 y 2002. Resultados: Se diagnosticaron 79 casos. La edad promedio de las pacientes fue 26,4 años. El diagnóstico de mola hidatidiforme fue sospechado clínicamente en 75,6 por ciento y en 24,4 por ciento fue hallazgo anatomopatológico. Los principales síntomas al ingreso fueron: dolor hipogástrico (75,6 por ciento), náuseas y/o vómitos (32,1 por ciento) y disuria (19,2 por ciento). Entre los signos clínicos destacan sangrado vaginal (83,3 por ciento), altura uterina discordante (25,3 por ciento) y expulsión de vesículas (12,8 por ciento). La ecografía concluyó mola hidatidiforme en 74,4 por ciento y quistes tecaluteínicos en 23,1 por ciento. Los hallazgos de anatomía patológica fueron mola completa (61,5 por ciento), mola parcial (31,2 por ciento) y coriocarcinoma (1,3 por ciento). En el seguimiento, 30,8 por ciento no volvieron a control y 23,1 por ciento tuvieron entre 7 y 12 controles. Conclusión: Los hallazgos de este estudio son similares a los descritos en la literatura.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Doença Trofoblástica Gestacional , Mola Hidatiforme/diagnóstico , Mola Hidatiforme/epidemiologia , Mola Hidatiforme/terapia , Chile/epidemiologia , Coriocarcinoma/diagnóstico , Coriocarcinoma/epidemiologia , Coriocarcinoma/terapiaRESUMO
OBJECTIVE: To assess the prevalence of unsuspected molar pregnancy in patients with first trimester spontaneous abortions. METHODS: An observational, cross-section study was carried out in 396 consecutive patients with diagnosis of first trimester spontaneous abortions, without clinical or ultrasonographic findings suggesting hydatidiform mole, a histological diagnosis was made from the curettage specimens, the cases with diagnosis of any trophoblastic disease prior of curettage were not included in the study. RESULTS: Diagnosis of molar pregnancy was made in 48 out of 396 patients (12.1%). There was not statistical difference in the sociodemographic variables and risk factors analyzed: patient age, familial incomes, years in scholar courses, prior pregnancies, deliveries, spontaneous abortions, number of sons, and prior hormone contraceptive use between the patients with diagnosed molar pregnancy and those patients without the diagnosis of molar pregnancy. CONCLUSION: The prevalence of unsuspected molar pregnancy found in our study (12.1%) was high and the suspicion in these cases according the risk factors of the disease could be difficult, therefore to rule out systematically molar pregnancy in each case of spontaneous abortions is recommended in order to avoid the complications associated with hydatidiform mole.
Assuntos
Aborto Espontâneo/etiologia , Mola Hidatiforme/complicações , Neoplasias Uterinas/complicações , Aborto Espontâneo/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Mola Hidatiforme/epidemiologia , Gravidez , Primeiro Trimestre da Gravidez , Prevalência , Neoplasias Uterinas/epidemiologiaRESUMO
En el Hospital Centro de Salud Israel Quintero Paredes Paján-Manabí, el número de casos de mola hidatiforme por año es importante, lo que motivó nuestra investigación. El objetivo fue analizar la incidencia de mola hidatiforme desde 1992 a 1998 y corroborar las características clínicas y epidemiológicas de las pacientes estudiadas. Se realizó un estudio retrospectivo, longitudinal y descriptivo. De un total de 1890 nacimientos, 14 presentaron embarazo molar, lo que dio una incidencia de un caso de mola por cada 135 nacimientos. La mayor frecuencia de edad, 36 por ciento fue en el estrato de 20-29 años, 36 por ciento fueron primigestas, la amenorrea promedio fue de 15 semanas y no hubo complicaciones. Los signos...
Assuntos
Mola Hidatiforme/epidemiologia , TrofoblastosRESUMO
A gravidez gemelar na qual coexistem um feto normal e uma mola completa é um evento raro. Complicaçoes clínicas e aumento de risco de malignizaçao sao de importância nesta patologia. Este trabalho descreve um caso de diagnóstico tardio em decorrência da presença do feto. Este diagnóstico foi feito no momento da resoluçao da gestaçao e confirmado por estudo histopatológico e citometria de fluxo. A resoluçao da gestaçao foi por via transpélvica em decorrência de hemorragia uterina maciça. O seguimento pós-molar evidenciou a persistência de níveis elevados de bhCG, obtendo-se remissao completa da doença com o uso de metotrexato. A luz deste caso, discutem-se o diagnóstico, a história natural e a conduta desta rara intercorrência na clínica obstétrica.
Assuntos
Humanos , Feminino , Adolescente , Mola Hidatiforme/epidemiologia , Gravidez Múltipla , Neoplasias Trofoblásticas , Hemorragia UterinaRESUMO
Hemos analizado 149 casos diagnosticados de mola hidatiforme en el Hospital gineco-obstétrico Isidro Ayora, fueron estudiados retrospectivamente. Durante el mismo período hubo 55.738 partos. La incidencia fue de un caso por cada 374 partos y 366 nacidos vivos, y una tasa de 2,67 por 1000 partos. De estos casos el 84.3 por ciento eran benignos y el 15.6 por ciento potencialmente malignos, luego de la investigación histopatológica. La mayor parte de pacientes estaban entre 14 y 20 años (28.1 por ciento). Mas de la mitad de las pacientes eran multigestas. El sangrado fue el signo más frecuente (81.2 por ciento). El 5.3 por ciento de los casos presentaron molas recurrentes. El tratamiento de elección en la mayoría de casos fue un legrado instrumental más un curetaje por succión...
Assuntos
Mola Hidatiforme/diagnóstico , Mola Hidatiforme/epidemiologia , Mola Hidatiforme/terapia , Equador , MaternidadesRESUMO
La Mola Hidatiforme es una patología del trofoblasto, caracterizada por degeneración hidrópica de las vellosidades coriales, desaparición de los vasos sanguíneos y proliferación de sincicio y citotrofoblasto. Existe un conocimiento general de la enfermedad, pronóstico, perfil de riesgo, tratamientos, etc., pero aún no existen datos sobre la evolución y los resultados perinatales de los Embarazos Post-Mola Hidatiforme. El objetivo fue determinar los resultados perinatales de los embarazos post-molares en el período de estudio y compararlos con los resultados perinatales de los embarazos de la población general del Instituto. Se realizó un estudio de tipo Caso Control, analizando 127 historias clínicas de pacientes con esta patología en el período de Enero de 1989 a Julio de 1996, en el Instituto de Maternidad y Ginecología Nta. Sra. de Las Mercedes. Se conformó el Lote Control con la población general de la institución del que fueron excluídos los casos de mola. Se registraron 41 embarazos posteriores a una Mola Hidatiforme: en el primer año posterior a la evacuación, el 61 por ciento de los embarazos culminó en aborto, en el segundo año la proporción de abortos fue el 21 por ciento y en el tercer y cuarto año el 100 por ciento de los embarazos llegó a término. Se encontró también correlación entre el grado de actividad trofoblástica: moderada, severa o atípica en el embarazo Molar previo, con la aparición de un aborto en embarazos subsiguientes. Conclusiones: Los embarazos Post Mola Hidatiforme con un intervalo intergenésico menor o igual a un año, tiene un Riesgo Relativo de 6,11 de sufrir un Aborto, a los dos años el Riesgo Relativo es de 2. Los casos de Mola Hidatiforme con un Grado de actividad Trofoblástica Moderada, Severa y Atípica tienen un Riesgo Relativo de 3,85 de sufrir un aborto en el embarazo subsiguiente. (AU)