scholarly journals UTERINE PERFORATION AS A SEQUEL TO REPEATED CURETTAGE FOR MOLAR

2003 ◽  
Vol 41 (143) ◽  
pp. 401-403
Author(s):  
Bekha Manandhar ◽  
A Rana ◽  
N Pradhan ◽  
A Amatya ◽  
R Sharma
Keyword(s):  
Vaginal Bleeding ◽  
Significant Proportion ◽  
Uterine Perforation ◽  
Gestational Trophoblastic Neoplasia ◽  
Beta Hcg ◽  
Emergency Hysterectomy

An 18 year old girl was subjected to emergency hysterectomy and unilateral salpingo-oophorectomy for uterine perforation because of repeated dilatation and curettagefor persisting vaginal bleeding following molar evacuation.As significant proportion of molar do progress into Gestational trophoblastic Neoplasiawhich in this case was choriocarcinoma; directs our attention to the fact that properfollow up of post molar cases using at least urinary beta HCG and institutingchemotherapy whenever necessary should be advocated in order to avoid such adrastic management.Key Words: Uterine perforation, molar, Gestational Trophoblastic Neoplasia (GTN)

scholarly journals Gestational trophoblastic neoplasia (invasive mole) following incomplete abortion- a rare case presenting with uterine perforation with gross hemoperitoneum: A case report

2017 ◽  
Vol 6 (4) ◽  
pp. 63-67
Author(s):  
G Neupane ◽  
S Acharya
Keyword(s):  
Rare Case ◽  
Single Agent ◽  
Emergency Laparotomy ◽  
Uterine Perforation ◽  
Gestational Trophoblastic Neoplasia ◽  
Vacuum Aspiration ◽  
Normal Limits ◽  
Incomplete Abortion ◽  
Beta Hcg ◽  
Invasive Mole

 Invasive mole is gestational trophoblastic neoplasia, characterized by aggressive invasion of the wall of the uterus by the trophoblastic cells. Here, we report a rare case of 17 years primigravida who presented with per vaginal bleeding and uterine perforation with gross hemoperitoneum about 1 month of manual vacuum aspiration of incomplete abortion. Resuscitation followed by emergency laparotomy with subsequent repair of uterine perforation was done. The patient received a total of 5 cycles of single agent chemotherapy (Methotrexate with leukovorin rescue). The beta hCG level became normal after 3 cycles of chemotherapy and further 2 cycles chemotherapy was administered. She was followed up for another 1 year in which her beta hCG levels were within normal limits. 

The Efficacy Of Emergency Hysterectomy In Peripartum Vaginal Bleeding

2012 ◽  
Vol 22 (3) ◽  
pp. 177-180
Author(s):  
Ömer Demirtaş ◽  
Hasan Terzi ◽  
Ünal Turkay ◽  
Ahmet Kale
Keyword(s):  
Vaginal Bleeding ◽  
Emergency Hysterectomy

scholarly journals Evaluation the Recurrence Risk of Gestational Trophoblastic Neoplasia (GTN) after Serum βhCG Normalization

2020 ◽  
Vol 10 (1) ◽  
pp. 194
Author(s):  
Azar Ahmadzadeh ◽  
Elham Karimi Moghaddam ◽  
Elahe Shafieyan
Keyword(s):  
Recurrence Rate ◽  
Initial Level ◽  
Recurrence Risk ◽  
Disease Stage ◽  
Multiple Drug ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Hospital Data ◽  
Beta Hcg ◽  
The Mean

Background: Although many GTN patients can be treated with chemotherapy, a small proportion of them will relapse after complete recovery. To the best of our knowledge, there is not any information in respect of relapsed GTN cases in our region. In the current study we have aimed to evaluation of the recurrence risk of gestational trophoblastic neoplasia (GTN) after serum βhCG normalization Methods: This descriptive-analytical study was carried out on registered hospital data of patients with confirmed GTN diagnosis following molar pregnancy who admitted to the gynecology ward of Imam Khomeini Hospital between 2011 and 2017. Patients with diagnosis of postmolar GTN, based on at least five bhcg measurements was included. Patients information including initial level of serum BhcG, time to Bhcg resolution, types of molar pregnancy, treatment protocols, need to recuretage relapse, and finally, the period time between bhcg resolution to relapse were evaluated. Results: In the present study, 239 patients with GTN (including 180 complete and 59 partial moles) were evaluated. The mean age of the patients was 28.8 years, ranging from 16 to 47 years. The mean βhCG concentration was 170,000 IU/ml (ranged 760 to 850,000). The mean time of βhCG resolution was 8.19 months in the range of 4 to 12 months. Recurrence was observed in 9 patients (3.7%). The mean period time between βhCG resolution to relapse was 20.94 months. The mean initial level of βhCG was significantly lower in patients with recurrence (p <0.0001). The highest recurrence rate was seen in those receiving multiple-drug chemotherapy. There was also a significant relationship between disease stage and recurrence rate. Conclusion: The findings of this study indicate that although the recurrence of GTN is relatively low, given the poor prognosis of these patients, continuous evaluation of bHCG levels for at least two years is essential to prevent disease progression.

scholarly journals The Curative Effect of a Second Curettage in Low-Risk Gestational Trophoblastic Neoplasia

2020 ◽  
Vol 10 (1) ◽  
pp. 88
Author(s):  
Azar Ahmadzadeh ◽  
Mahin Najafian ◽  
Kosar Lalvand
Keyword(s):  
Drug Exposure ◽  
Endometrial Thickness ◽  
Single Agent ◽  
Low Risk ◽  
Gestational Trophoblastic Neoplasia ◽  
Kaplan Meier ◽  
Beta Hcg ◽  
Response To Chemotherapy ◽  
Time Required ◽  
Single Agent Chemotherapy

Background: Gestational trophoblastic neoplasia (GTN), despite its widespread metastases, is a very common cancer in women that is curable. Although the GTN cases show a good response to chemotherapy, in an effort to reduce toxic drug exposure, the second curettage has been suggested for some patients. In the current study, we have aimed to compare the benefits of the second curettage in comparison with single-agent chemotherapy for low-risk GTN patients. Methods: This retrospective observational study was carried out on GTN patients admitted to the gynecology department of Imam Khomeini Hospital in Ahvaz. The demographic profile of all participants was extracted. Patients' hospitalization records were also extracted from the files. Patients with an endometrial thickness above 10 mm were treated with re-curettage. The β hCG clearance time was estimated by the Kaplan Meier plot. Results: In the present study, 148 patients with low-risk GTN stage 1 were studied. The time required for β-hCG clearance in patients undergoing re-curettage was significantly lower than the chemotherapy receiving group (7 months vs. 10 months, p <0.0001). More than 50% of patients treated by re- curettage without needing chemotherapy. Moreover, the other 50% cases needed chemotherapy the number of courses was significantly lower than those received single-agent chemotherapy alone (p <0.0001). The baseline β-hCG levels were significantly lower in those who did not need chemotherapy (p = 0.012). β-hCG resolution occurred more rapidly in patients undergoing re-curettage alone, while, those who received only chemotherapy had a longer duration for β-hCG clearance. Conclusion: In general, the findings of this study showed that re-curettage could be used effectively in the treatment of GTN following molar pregnancy. This treatment reduces or eliminates the need for chemotherapy. Our findings also showed that the initial level of β-hCG could be considered as a predictive factor in response to curettage.

scholarly journals Hemoperitoneum from suspected uterine perforation: Nonsurgical management of a case of choriocarcinoma. A case report

1970 ◽  
Vol 2 (1) ◽  
pp. 71-73 ◽  
Author(s):  
Pramila Pradhan
Keyword(s):  
Case Report ◽  
Acute Abdomen ◽  
High Serum ◽  
Local Resection ◽  
Uterine Perforation ◽  
Gestational Trophoblastic Neoplasia ◽  
Nonsurgical Management ◽  
Intraperitoneal Haemorrhage

A case of choriocarcinoma presented as an acute abdomen because of intraperitoneal haemorrhage from uterine perforation, 4 weeks after second and 11 weeks following first suction evacuation with high serum hCG level and metastases to vagina and lungs. Once the uterine perforation occurs following gestational trophoblastic neoplasia, immediate laparotomy has been performed usually followed either by local resection or hysterectomy depending on situation. This case is an exception, which was conservatively managed by chemotherapy, EMA-CO regime successfully with no remission on follow up. Keywords: choriocarcinoma, intraperitoneal haemorrhage, uterine perforation.       doi:10.3126/njog.v2i1.1483 N. J. Obstet. Gynaecol Vol. 2, No. 1, p. 71 - 73 May -June 2007

scholarly journals Uterine Perforation & Abortion- A Case Report

KYAMC Journal ◽  
2017 ◽  
Vol 5 (1) ◽  
pp. 491-493
Author(s):  
Mst Atia Sultana ◽  
Rakib Uddin ◽  
Rubiyat Farzana Hussain ◽  
Masuma Khatun
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Vaginal Bleeding ◽  
Abdominal Cavity ◽  
Uterine Cavity ◽  
Lower Abdominal Pain ◽  
Placental Tissue ◽  
Uterine Perforation ◽  
Gentle Traction ◽  
Cord Prolapse

Sreemoti Ratna Sarker 30 years old lady presented to us with the complaints of amenorrhea for 5 months, lower abdominal pain for 5 days, slight per vaginal bleeding for 2-3 days, a cord like structure is coming down p/v on the day of admission. On general examination she was stable and on p/v examination there was cord prolapse. A gentle traction was given and it was expelled out along with a small piece of placental tissue without any fetal parts and bleeding. Then she was advised for USG of abdomen. USG reported a fetus like structure in the abdominal cavity and the empty uterine cavity . She was managed surgically. Now she is doing well.KYAMC Journal Vol. 5, No.-1, Jul 2014, Page 491-493

SPONTANEOUS HETEROTOPIC PREGNANCY WITH UNSTABLE VITALS: A CASE REPORT

2021 ◽  
pp. 35-36
Author(s):  
Anshika Agarwal
Keyword(s):  
Early Diagnosis ◽  
Vaginal Bleeding ◽  
Clinical Symptoms ◽  
Transvaginal Ultrasound ◽  
Heterotopic Pregnancy ◽  
Intrauterine Pregnancy ◽  
Spontaneous Conception ◽  
Beta Hcg ◽  
Maternal Morbidity And Mortality ◽  
Life Threatening

A spontaneous heterotopic pregnancy is a rare obstetric entity which can be life threatening if early diagnosis is missed. There is co-existing intra uterine and extra uterine pregnancy, most often tubal and rarely cervical or ovarian. It is extremely rare in spontaneous conception but incidence is increasing with the use of ART’s. Early diagnosis is difcult probably because of the lacking clinical symptoms. It usually presents as a ruptured ectopic pregnancy. Timely diagnosis and intervention is of utmost importance to prevent maternal morbidity and mortality. Abdominal pain, swelling, peritoneal irritation, enlarged uterus, vaginal bleeding, pallor, tachycardia, features of shock may be a few presenting features. With the advances in technology, transvaginal ultrasound proves to be a great diagnostic tool in early diagnosis of heterotopic pregnancy. Serum beta-hcg levels is of importance. Intervention can be medical or surgical depending on the hemodynamic condition of the patient and the viability of the intrauterine pregnancy. Heterotopic pregnancy is an unusual diagnosis and so is often ignored in the presence of an intrauterine pregnancy. But as it can prove to be life threatening so its diagnosis as a differential should always be kept in mind. Early diagnosis and prompt and effective treatment can save a life or two!

scholarly journals A molar pregnancy detected by following irregular vaginal bleeding after a first trimester evacuation: rare case report

2019 ◽  
Vol 8 (6) ◽  
pp. 2549
Author(s):  
Meena Bhati Salvi
Keyword(s):  
Case Report ◽  
Vaginal Bleeding ◽  
Transvaginal Ultrasound ◽  
Correct Diagnosis ◽  
First Trimester ◽  
Molar Pregnancy ◽  
Sequence Of Events ◽  
Beta Hcg ◽  
Surgical Evacuation ◽  
Invasive Mole

In this case report summarizes the sequence of events that led to detection of a molar pregnancy missed by ultrasound and initial pathology examination. A 29 years old Asian nulliparous patient came to our clinic with missed period. On beta HCG she was 6 weeks pregnant. After 20 days she was diagnosed with 7 weeks missed abortion on ultrasound. surgical evacuation done for same. After 3 weeks she came with irregular vaginal bleeding. After physical and vaginal examination Beta HCG done, which was very high. On transvaginal ultrasound partial molar pregnancy was detected, so she was immediately admitted and repeat surgical evacuation was done. Histopathology report confirmed partial molar pregnancy which was not detected in previous report. She was regularly followed up with Beta HCG value up to 1 year which declined dramatically. Though molar pregnancy is rare, but it has the potential to develop into invasive mole, so any abnormal bleeding post evacuation should be followed up properly. Beta HCG values and histopathological evaluation is important for correct diagnosis and follow up.

scholarly journals Uterine Rescue in High-Risk Gestational Trophoblastic Neoplasia Treated with EMA-CO by Uterine Arteries Embolization due to Arteriovenous Malformations

2021 ◽  
Vol 43 (04) ◽  
pp. 323-328
Author(s):  
Arlley Cleverson Belo da Silva ◽  
Jurandir Piassi Passos ◽  
Roney Cesar Signorini Filho ◽  
Antonio Braga ◽  
Rosiane Mattar ◽  
...  
Keyword(s):  
High Risk ◽  
Vaginal Bleeding ◽  
Hydatidiform Mole ◽  
World Health ◽  
Complete Regression ◽  
Gestational Trophoblastic Neoplasia ◽  
Sonographic Examination ◽  
Complete Control ◽  
Uterine Arteries ◽  
Gynecology And Obstetrics

AbstractComplete hydatidiform mole (CHM) is a rare type of pregnancy, in which 15 to 20% of the cases may develop into gestational trophoblastic neoplasia (GTN). The diagnostic of GTN must be done as early as possible through weekly surveillance of serum hCG after uterine evacuation. We report the case of 23-year-old primigravida, with CHM but without surveillance of hCG after uterine evacuation. Two months later, the patient presented to the emergency with vaginal bleeding and was referred to the Centro de Doenças Trofoblásticas do Hospital São Paulo. She was diagnosed with high risk GTN stage/score III:7 as per The International Federation of Gynecology and Obstetrics/World Health Organization (FIGO/WHO). The sonographic examination revealed enlarged uterus with a heterogeneous mass constituted of multiple large vessels invading and causing disarrangement of the myometrium. The patient evolved with progressive worsening of vaginal bleeding after chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA-CO) regimen. She underwent blood transfusion and embolization of uterine arteries due to severe vaginal hemorrhage episodes, with complete control of bleeding. The hCG reached a negative value after the third cycle, and there was a complete regression of the anomalous vascularization of the uterus as well as full recovery of the uterine anatomy. The treatment in a reference center was essential for the appropriate management, especially regarding the uterine arteries embolization trough percutaneous femoral artery puncture, which was crucial to avoid the hysterectomy and allow GTN cure and maintenance of reproductive life.

scholarly journals Endometrial biopsy is an important diagnostic tool for the evaluation of abnormal uterine bleeding

2021 ◽  
Vol 4 (1) ◽  
pp. 19-22
Author(s):  
Jaafar Makki ◽  
Ali hussein Al Khafaj
Keyword(s):  
Vaginal Bleeding ◽  
Endometrial Hyperplasia ◽  
Hydatidiform Mole ◽  
Endometrial Biopsy ◽  
Endometrial Polyp ◽  
Uterine Perforation ◽  
Organic Disease ◽  
Normal Endometrium ◽  
Chronic Endometritis ◽  
Abnormal Vaginal Bleeding

In this study 100 biopsies were taken from the endometrium of childbearing women (18-50 yrs. of age) suffering from abnormal vaginal bleeding from Jan 2019-Dec 2019. Endometrial Biopsy (EB) is safe, an outpatient procedure, low cost, carries out without general anesthesia & the incidence of hemorrhage, infection & uterine perforation are less common than with D&C. EB is an alternative to dilatation & curette (D&C) for the evaluation of infertile & abnormal vaginal bleeding or dysmenorrheic patients. There are two main groups of causes to irregular vaginal bleeding. 1. Organic disease (74% of the cases), in this group there are obvious lesion such as, endometrial polyp, endometrial hyperplasia & chronic endometritis. The most common cause was endometrial hyperplasia 48%, it is commonly seen during the perimenopausal period (40-50yr). Less common causes include chronic endometritis 8%, hydatidiform mole 7%, and endometrial polyp 7%. 2. non-organic disease comprises 19% of all cases, anovulatory period 13% or Luteal phase insufficiency 6%. They are commonly seen from age of 18-40yrs. 6% of the cases found to have normal endometrium. 5 endometrial biopsies were inadequate & unsatisfactory for histopathological interpretation. The aim of this study is to evaluate the usefulness & disadvantages of EB & to compare it with the traditional method of endometrial curette.

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