Conservative Management of Uterine Rupture in Gestational Trophoblastic Neoplasia: A Report of 2 Cases

2009 ◽  
Vol 19 (9) ◽  
pp. 1666-1670 ◽  
Author(s):  
Jenny Lynn DC. Estrella ◽  
Agnes L. Soriano-Estrella
Keyword(s):  
Uterine Rupture ◽  
Primary Repair ◽  
Single Agent ◽  
Reproductive Age ◽  
Gestational Trophoblastic Neoplasia ◽  
Small Areas ◽  
Uterine Tumors ◽  
Future Fertility ◽  
Lethal Management ◽  
Desired Family Size

Cases of gestational trophoblastic neoplasia (GTN) with uterine rupture are often catastrophic owing to profuse bleeding, which could be potentially lethal. Management often entails removal of the uterus. Among patients in the reproductive age who have not completed their desired family size, such a procedure could be unacceptable. To address this, uterine resection of localized disease has been performed to preserve fertility. However, in some cases, resection would not leave much of the uterus for future fertility. Hence, primary repair of the rupture could be done. Two cases of uterine rupture in low-risk GTN conservatively managed with primary uterine rupture repair using hemostatic stitches and postoperative single-agent chemotherapy are presented. Both patients were in their early reproductive years and with a great desire to preserve future fertility. The extent of the disease was evaluated in both cases intraoperatively before considering this conservative approach. Such management proved to be effective for both cases. The 2 cases presented are the first reported successful cases in literature on which primary repair of uterine tumor rupture by oversewing with figure-of-eight stitches were done. One should then consider this as a new option in the management of patients who have GTN with uterine rupture, highly desirous of pregnancy, with large uterine tumors but relatively small areas of rupture for which simple stitches would suffice in providing adequate hemostasis.

scholarly journals State-of-the-Art Workup and Initial Management of Newly Diagnosed Molar Pregnancy and Postmolar Gestational Trophoblastic Neoplasia

2019 ◽  
Vol 17 (11) ◽  
pp. 1396-1401 ◽  
Author(s):  
Kevin M. Elias ◽  
Ross S. Berkowitz ◽  
Neil S. Horowitz
Keyword(s):  
Clinical Stage ◽  
Single Agent ◽  
False Negative ◽  
First Trimester ◽  
Low Risk ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Gynecology And Obstetrics ◽  
Dilation And Curettage ◽  
Future Fertility

Gestational trophoblastic disease refers to a series of interrelated tumors arising from the placenta, including benign molar pregnancies as well as the malignant conditions termed gestational trophoblastic neoplasia (GTN). GTN most commonly follows a molar pregnancy but may develop after any gestation. The wide availability of first trimester ultrasound and serum human chorionic gonadotropin (hCG) measurement has changed the presentation of molar pregnancy in recent decades from a second trimester to a first trimester disease, such that most patients have few symptoms at diagnosis. With identification of molar pregnancy at earlier gestations, accurate diagnosis increasingly relies on expert histopathology coupled with ancillary molecular and genetic techniques. However, earlier diagnosis has not changed the risk of postmolar GTN. Although most molar pregnancies are treated with dilation and curettage, hysterectomy may be appropriate in select cases when future fertility is not desired. After treatment of molar pregnancy, close surveillance with serial hCG monitoring is essential to diagnose GTN and identify the need for chemotherapy. Physicians following hCG levels should understand the performance characteristics of the test, including common causes of false-positive and false-negative results. After a diagnosis of postmolar GTN is made, selection of single-agent or multiagent chemotherapy depends on accurate assignment of the clinical stage and risk stratification by the International Federation of Gynecology and Obstetrics (FIGO) prognostic scoring system. Surgical treatment of postmolar low-risk GTN, including both second uterine curettage and hysterectomy, may decrease subsequent need for or duration of chemotherapy. Cure rates for postmolar low-risk GTN approach 100%, and subsequent pregnancy outcomes for patients reflect those of the general population.

scholarly journals Gestational trophoblastic neoplasia: Retrospective analysis of clinical profile, treatment pattern and outcome

2016 ◽  
Author(s):  
Paramjeet Kaur ◽  
Ashok K. Chauhan ◽  
Anil Khurana ◽  
Yashpal Verma ◽  
Nupur Bansal
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Hydatidiform Mole ◽  
Single Agent ◽  
High Risk Group ◽  
Treatment Pattern ◽  
Gestational Trophoblastic Neoplasia ◽  
Trophoblastic Tumor ◽  
Villous Trophoblast ◽  
Invasive Mole

Background: Gestational trophoblastic disease is a spectrum of cellular proliferation arising from the placental villous trophoblast. Gestational triphoblastic neoplasia (GTN) is a collective term for GTD that invade locally or metastasize. GTD includes hydatidiform mole (complete and partial) and GTN include invasive mole, choricocarcinoma, placental site trophoblastic tumor and epitheliod trophoblastic tumor. Aim: To evaluate clinicopathological profile, treatment pattern and clinical outcome in patients with gestational trophoblastic neoplasia (GTN). Materials and Methods: Twelve cases of gestational trophoblastic neoplasia treated between 2012 to November 2015 in deptt of Radiotherapy – II, PGIMS, Rohtak were evaluated in this retrospective study. Data was analyzed on the basis of age, histopathology, stage, type of treatment received and treatment related toxicities. Disease free survival was estimated. Results: Out of 12 women 7 (58 %) had hydatidiform mole, 4 (33%) invasive mole and 01 (8%) had choriocarcinoma. All the cases were given chemotherapy. Two patients had low risk disease. Among high risk group seven patients had score of less than 7 and five patients had risk score of 7 or higher. Five patients were given single agent methotrexate, seven patients received multidrug regimens. All patients are on regular follow up. One patient (high risk group) expired as she did not receive treatment. Conclusion: GTN are rare and proliferative disorders with proper diagnosis and treatment most of the cases are amenable to treatment with favorable outcome.

scholarly journals Gestational trophoblastic neoplasia: A 6 year retrospective study

2014 ◽  
Vol 03 (01) ◽  
pp. 033-037 ◽  
Author(s):  
Sushruta Shrivastava ◽  
Amal Chandra Kataki ◽  
Debabrata Barmon ◽  
Pankaj Deka ◽  
Chidananda Bhuyan ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Complete Remission ◽  
Risk Score ◽  
Single Agent ◽  
Response To Treatment ◽  
Gestational Trophoblastic Neoplasia ◽  
Response To Chemotherapy ◽  
Chemotherapy Patients ◽  
Line Chemotherapy

Abstract Aims and Objectives: To study the clinical presentations of gestational trophoblastic neoplasia and its response to chemotherapy. Materials and Methods: This is a retrospective study of 28 women of gestational trophoblastic neoplasia evaluated over a period of 6 years from January 2004 to December 2009. Patients were evaluated on the basis of their age, number of deliveries, history of abortion or molar pregnancy, and the treatment received. All patients were scored on the basis of WHO scoring system. Patients with low risk (score </=6) received single agent chemotherapy with methotrexate or actinomycin D. Patients with high risk (score >/=7) received multiple agent chemotherapy with EMACO regimen. After completion of chemotherapy patients were followed for a minimum of 2 years. The response to treatment was evaluated during follow-up by clinical examination, beta hCG levels and imaging as and when required. Results: Out of 28 women only 27 could be evaluated, because 1 patient was lost to follow-up. Out of 27 patients, 18 patients (66.67%) achieved complete remission with the first-line chemotherapy and additional 25.92% (7/27) achieved complete remission with second line chemotherapy resulting in complete remission of 92.5% (25/27). Conclusion: Gestational trophoblastic neoplasia is curable if patient is properly evaluated and scored. It shows good response to chemotherapy.

scholarly journals Caesarian Scar Pregnancy - A Diagnostic Dilemma

2016 ◽  
Vol 54 (202) ◽  
pp. 88-90
Author(s):  
Pratiksha Gupta ◽  
Anju Huria ◽  
Dilpreet Kaur ◽  
Reeti Mehra
Keyword(s):  
Uterine Rupture ◽  
Maternal Morbidity ◽  
Transvaginal Ultrasound ◽  
Morbidity And Mortality ◽  
Diagnostic Dilemma ◽  
Color Flow ◽  
Major Hemorrhage ◽  
Future Fertility ◽  
Risk Of Rupture ◽  
Maternal Morbidity And Mortality

Caesarean scar pregnancy is one of the rarest forms of ectopic pregnancy. Transvaginal ultrasound and color flow Doppler provides a high diagnostic accuracy. A delay in diagnosis and treatment can lead to uterine rupture, major hemorrhage, hysterectomy and serious maternal morbidity and mortality. Early diagnosis can offer treatment options of avoiding uterine rupture and hemorrhage, thus preserving the uterus and future fertility. Primary health care provider should know about this rare entity, because if diagnosed timely, and referral to specialized centre is done without delay will definitely save maternal morbidity and mortality. Management plan should be individualized. Termination of pregnancy is the treatment of choice in the first trimester. Expectant treatment has a poor prognosis because of risk of rupture. In this case report we aim to discuss the associated diagnostic dilemma, most appropriate methods of diagnosis and management, with their implications in clinical practice.Keywords: scar pregnancy; caesarian section; methotrexate. | PubMed

Advances in Fertility Preservation for Young Women With Cancer

2018 ◽  
pp. 27-37 ◽  
Author(s):  
Karen Lisa Smith ◽  
Clarisa Gracia ◽  
Anna Sokalska ◽  
Halle Moore
Keyword(s):  
Fertility Preservation ◽  
Young Female ◽  
Current Data ◽  
Reproductive Age ◽  
Fertility Treatment ◽  
Ovarian Suppression ◽  
Female Patients ◽  
Ovarian Protection ◽  
Future Fertility ◽  
Reproductive Techniques

Female patients of reproductive age with cancer often require treatment that can compromise their future fertility. Treatment-related infertility is an important cancer survivorship issue and is associated with depression and diminished quality of life. Recent advances in reproductive health care provide the opportunity to preserve fertility prior to the initiation of cancer therapy. Clinical guidelines recommend that oncology providers counsel patients about the risk of treatment-related infertility and fertility preservation options, and that they refer those who are interested in fertility preservation to fertility specialists. Guidelines endorse the use of assisted reproductive techniques (ART) provided by reproductive endocrinologists to preserve fertility in young female patients with cancer. In addition, ovarian suppression with gonadotropin-releasing hormone (GnRH) agonists may be considered for ovarian protection during chemotherapy. This article reviews currently available and emerging ART for fertility preservation in female patients of reproductive age with cancer and current data supporting the use of ovarian suppression for ovarian protection during chemotherapy in this population. We also review the uptake of fertility services and discuss barriers to fertility preservation in female patients of reproductive age with cancer.

scholarly journals Caesarean scar ectopic pregnancy

2018 ◽  
Vol 7 (5) ◽  
pp. 2038
Author(s):  
T. Ramani Devi ◽  
T. Sweta ◽  
C. Archana Devi
Keyword(s):  
Ectopic Pregnancy ◽  
Conservative Management ◽  
Abdominal Cavity ◽  
Delayed Diagnosis ◽  
Reproductive Age ◽  
Mortality And Morbidity ◽  
Caesarean Scar ◽  
Future Fertility ◽  
Laparoscopic Excision ◽  
Life Threatening

Ectopic pregnancy is a common cause of mortality and morbidity among the women of reproductive age group. Tubal pregnancy is the commonest.  It can occur in cervix, ovaries, previous caesarean scar, interstitial portion of the tube and abdominal cavity. Here we report a case of caesarean scar ectopic pregnancy which was managed conservatively. 31 yrs old gravid 3 previous 1 LSCS and 1 tubal ectopic come for antenatal consultation at 35 days of gestation. UPT was Positive. USG showed no evidence of intra uterine sac. Repeat scan after 10 days showed a gestational sac at the lower uterine segment scar. Hence it was decided for conservative management, injection methotrexate 50 mgm X 2 doses given. This was followed by misoprost vaginal insertion. Since patient did not expel the sac, injection PG F2 alpha 125 mg x 2 doses were given. Patient expelled the products of conception partially. This was followed by hysteroscopic guided evacuation.Caesarean scar ectopic was reported in 1978. Early diagnosis is by TV USG / MRI. Early ectopic can be treated medically. In delayed diagnosis, laparoscopic excision of the scar has to be done. In rupture of the scar site ectopic pregnancy laparotomy is indicated. In the event of heavy bleeding, hysterectomy has to be done. After conservative management and excision of the scar, fertility is not altered. Caesarean section scar pregnancy is a rare form of ectopic pregnancy which can lead to life threatening complications leading to mortality and morbidity. Treatment has to be individualized according to the gestational age, haemodynamic stability and desire for future fertility.

Single Agent Arsenic Trioxide in the Treatment of Newly Diagnosed Acute Promyelocytic Leukemia: Long Term Follow-up Data.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 846-846
Author(s):  
Vikram Mathews ◽  
Biju George ◽  
Kavitha M Lakshmi ◽  
Auro Viswabandya ◽  
Ezhilarasi Chendamarai ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Single Agent ◽  
High Risk Group ◽  
Reproductive Age ◽  
Newly Diagnosed ◽  
Long Term Follow Up ◽  
Good Risk

Abstract Abstract 846 We had previously reported a well tolerated regimen using single agent arsenic trioxide (ATO) (Blood 2006:107; 2627) leading to durable remissions in patients with newly diagnosed acute promyelocytic leukemia (APL). Briefly, the regimen consisted of ATO (10mg/day for adults and 0.15mg/kg/day for pediatric patients) for up to 60 days in induction; this was followed by a 28 day consolidation after a 4 week break. Four weeks after completion of consolidation, patients received ATO for 10 days/month for 6 months. A concern with the previous report was the relatively short duration of follow up. Here we report the long term follow-up data of the same cohort. As previously reported, 72 newly diagnosed cases of APL were enrolled. 62 patients (86.1%) achieved hematological remission. The remaining died prior to achieving remission. There were no primary induction failures. Twenty two (30.6%) of these patients were considered good risk group (WBC count at diagnosis <5×109/L and a platelet count >20×109/L), the rest were considered high risk. Since publication of the last report an additional 7 patients have relapsed to give a total of 13 relapses, 2 were in the good risk group and the remaining 11 in the high risk group. The relapses in the good risk group were salvaged with an autologous SCT and have durable continued second remissions. The median time to relapse was 1.5 years. Five (38.52%) of these relapses occurred beyond 2 years and included both relapses in the good risk group. At a median follow-up of 58 months the 5-year Kaplan-Meier overall survival (OS), event free survival (EFS) and disease free survival (DFS) of the entire cohort was 74.22±5.26%, 68.93±5.52% and 80.00±5.17% respectively. The 5-year OS and EFS of the good risk and high risk group was 100±00% vs. 63.30±6.9% and 90.00±6.71% vs. 59.66±6.99% respectively. Beyond induction, all deaths followed relapse of disease. There were no second malignancies reported. Besides the previously reported toxicities, which were mild and transient in most cases, there were no new toxicities that were reported on continued follow up of these cases. Since completion of therapy, in spite of counseling and advising against pregnancy, 3 males and 4 females in the reproductive age group have had 8 normal children. No abortions, still births or fetal defects were reported among patients in the reproductive age group in this cohort. Hair and nail samples from 5 cases that had completed maintenance therapy more than 24 months earlier have been collected for analysis, the results of which are awaited. At our center the cost of administering this regimen is a quarter of that of a conventional ATRA plus anthracycline based regimen. Additionally, after the initial induction therapy the rest of the treatment did not require hospital admission nor did it result in any Grade III/IV hematological toxicity. Single agent ATO based regimen as reported previously is well tolerated, results in durable remissions and does not have any significant late side effects. In the good risk group it is associated with excellent clinical outcomes while in the high risk group additional interventions are probably required to reduce the risk of late relapses. In a resource constrained environment it is probably the best option. Disclosures: No relevant conflicts of interest to declare.

Etoposide-Actinomycin as Salvage Regimen for the Treatment of Nonmetastatic and Low-Risk Metastatic Gestational Trophoblastic Neoplasia: Experience at the Philippine General Hospital

2016 ◽  
Vol 26 (5) ◽  
pp. 977-983 ◽  
Author(s):  
Mariel S. Nevado-Gammad ◽  
Agnes L. Soriano-Estrella
Keyword(s):  
General Hospital ◽  
Remission Rate ◽  
Single Agent ◽  
Salvage Chemotherapy ◽  
Normal Serum ◽  
Salvage Treatment ◽  
Low Risk ◽  
Gestational Trophoblastic Neoplasia ◽  
Salvage Regimen ◽  
Trophoblastic Diseases

ObjectivesSingle-agent chemotherapy has been the standard of treatment for nonmetastatic and metastatic low-risk gestational trophoblastic neoplasia (GTN). However, it is estimated that approximately 12% to 32% of patients given single-agent therapy will require a change of chemotherapy regimen because of drug resistance and/or intolerable toxicity. The Section of Trophoblastic Diseases of the Philippine General Hospital started using the combination of etoposide-actinomycin (EA) as salvage chemotherapy in the early 2000s. This study was carried out to describe the local experience with this salvage chemotherapy.Materials and MethodsThis is a retrospective descriptive study aimed to analyze the efficacy and safety of the EA regimen as salvage treatment for the management of nonmetastatic and low-risk metastatic GTN. Records of the Section of Trophoblastic Diseases of the Philippine General Hospital from January 1, 2002 to June 30, 2014 were reviewed to identify all patients who had a diagnosis of nonmetastatic and metastatic low-risk GTN. Primary remission rate and toxicity profile of all patients who received the EA regimen as salvage treatment were determined.ResultsDuring the study period, a total of 67 cycles of the EA regimen were administered to 15 patients as salvage chemotherapy. Patients received a median of 4 cycles of EA, attaining normal serum beta human chorionic gonadotropin after 2 to 3 cycles. Thirteen of the 15 patients achieved complete remission with the EA regimen, giving a remission rate of 87%. The major toxicity that the patients experienced was myelosuppression. Grade 1/2 anemia was addressed by blood transfusion. Grade 3 neutropenia/myelosuppression was addressed by the administration of granulocyte colony-stimulating factor. Alopecia was seen in all of the patients. One patient experienced dermatitis with accompanying myelosuppression.ConclusionThe EA regimen was efficacious and well tolerated for the treatment of refractory nonmetastatic and low- risk metastatic GTN.

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