Management of symptomatic uterine arteriovenous malformations after gestational trophoblastic disease: The Brazilian experience and possible role for depot medroxyprogesterone acetate and tranexamic acid treatment

Autor: Braga, Antonio, Lima, Lana, Medeiros Parente, Raphael Camara, Roger Keller Celeste, Rezende Filho, Jorge, Amim Junior, Joffre, Maesta, Izildinha, Sun, Sue Yazaki, Uberti, Elza, Lin, Lawrence, Madi, Jose Mauro, Viggiano, Mauricio, Elias, Kevin M., Horowitz, Neil S., Berkowitz, Ross S.
Přispěvatelé: Brazilian Association of Gestational Trophoblastic Disease, Perinatal Health of Rio de Janeiro Federal University, Fluminense Federal University, Universidade Estadual Paulista (UNESP), Universidade Federal de São Paulo (UNIFESP), Mario Totta Maternity Ward of Irmandade da Santa Casa de Misericordia Hospital, Universidade de São Paulo (USP), Caxias do Sul General Hospital of Caxias do Sul University, New England Trophoblastic Disease Center, Harvard Medical School
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Zdroj: Scopus
Repositório Institucional da UNESP
Universidade Estadual Paulista (UNESP)
instacron:UNESP
Web of Science
Popis: Made available in DSpace on 2022-04-29T08:27:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-01 OBJECTIVE: To identify predictive variables of heavy vaginal bleeding from uterine arteriovenous malformation (uAVM) after gestational trophoblastic disease (GTD) and review outcomes with different treatment strategies. STUDY DESIGN: This is a retrospective study of patients with uAVM presenting with vaginal bleeding after postmolar follow-up or treatment for postmolar gestational trophoblastic neoplasia, with normal hCG levels for at least 6 or 12 months, respectively, followed at 9 Brazilian GTD reference centers, from January 2004– January 2016. Patients were treated preferentially with uterine artery embolization (UAE), but when UAE wasnot available, depot medroxyprogesterone acetate and tranexamic acid (DMPA+TA) was offered. RESULTS: The incidence of symptomatic uAVM after GTD was 0.6% (39/6,129). Risk factors associated with class III–IV hemorrhage included number of previous curettages (aRR 4.23, 95% CI 1.36–13.1, p=0.013), uterine artery index of resistance ≤0.32 (aRR 35.2, 95% CI 3.58–347.5, p= 0.002), and uterine artery peak systolic velocity ≥78.7 cm/s (aRR 10.7, 95% CI 1.15–100.6, p=0.037). Patients with class I–II hemorrhage treated with DMPA+TA had a higher rate of uAVM resolution (N=14/16 [87.5%]) versus UAE (N=4/8 [50%], p=0.033). Pa-tients with class III–IV hemorrhage were 87% less likely to have successful treatment with DMPA+TA compared to class I–II hemorrhage (cRR 0.13, 95% CI 0.02–0.83, p=0.013). CONCLUSION: Although UAE is preferred for cases of heavy vaginal bleeding, there may be a role for DMPA+TA in the management of less severe bleeding complications. Rio de Janeiro Trophoblastic Disease Center Brazilian Association of Gestational Trophoblastic Disease Department of Gynecology and Obstetrics Faculty of Medicine Maternity School Perinatal Health of Rio de Janeiro Federal University Department of Maternal-Child Faculty of Medicine Antonio Pedro University Hospital Fluminense Federal University Department of Preventive and Social Dentistry Federal University of Rio Grande do Sul Sao Paulo State University Botucatu Trophoblastic Disease Center Department of Gynecology and Obstetrics Botucatu Medical School Sao Paulo State University Universidade Federal de Sao Paulo Mario Totta Maternity Ward of Irmandade da Santa Casa de Misericordia Hospital Sao Paulo Clinics Hospital of the University of Sao Paulo Caxias do Sul General Hospital of Caxias do Sul University Clinical Hospital of Goias Federal University Division of Gynecologic Oncology Departments of Obstetrics and Gynecology and of Reproductive Biology New England Trophoblastic Disease Center Division of Gynecologic Oncology Departments of Obstetrics and Gynecology and of Reproductive Biology New England Trophoblastic Disease Center Brigham and Women’s Hospital Dana-Farber Cancer Institute Harvard Medical School Department of Preventive and Social Dentistry Federal University of Rio Grande do Sul Sao Paulo State University Botucatu Trophoblastic Disease Center Department of Gynecology and Obstetrics Botucatu Medical School Sao Paulo State University
Databáze: OpenAIRE
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