Gestational trophoblastic disease (GTD) is a spectrum of tumours tumour. The last three are termed gestational trophoblastic .. ACOG Technical Bulletin Gestational trophoblastic disease (GTD) forms a group of disorders spanning the conditions of complete and partial molar pregnancies through to the malignant. Gestational Hypertension and Preeclampsia ACOG Practice Bulletin # Diagnosis and Treatment of Gestational Trophoblastic Disease If you are an ACOG Fellow and have not logged in or registered to Obstetrics & Gynecology, please follow these Thyroid Disease in Pregnancy · Practice Bulletin No.
|Published (Last):||25 November 2013|
|PDF File Size:||20.61 Mb|
|ePub File Size:||11.10 Mb|
|Price:||Free* [*Free Regsitration Required]|
Gestational tro- complications of molar pregnancy.
Diagnosis and treatment of gestational trophoblastic disease: ACOG Practice Bulletin No.
A serum hCG determination plete the evacuation of moles after medical induction of and exclusion of pregnancy are all that are required to labor 9. Gestational choriocarci- curettage is not recommended because it does not often noma is a malignancy, comprising both neoplastic syn- induce remission or influence treatment and may result cytiotrophoblast and cytotrophoblast elements without in uterine perforation and hemorrhage Indexed in Web of Science.
Clinical features of multiple conception with partial or complete molar pregnancy A baseline marked uterine enlargement 9, 17, This experience responds to the advocacy calls of various GTD management Centers of Excellence for the creation of reference healthcare structures, with a well-established organization, a codified and comprehensive management program, and proactive surveillance mechanisms, based on a customized model of patient-practitioner partnership.
Gynecologic oncology93 3 Given the absence of referent histopathologist in GTD in Morocco, this surveillance scheme was adopted for both complete hydatidiform moles CHM and partial hydatidiform moles PHM to ensure higher security for patients and avoid the consequences of a potential underestimated diagnosis.
This could explain the attitude of rushing into a new pregnancy for our 2 patients, especially in a cultural context where proof of fertility is essential for every young married woman.
Most studies have been retrospec- No prior chemotherapy tive analyses of single-institution experiences, but these confirm high activity for a variety of agents in the treat- Poor-prognosis metastatic Any risk factor: These The WHO prognostic index score assigned a patients are not only at an increased risk of failure of sin- weighted value to several individual clinical variables 4, gle-agent chemotherapy but also have an increased risk Twiggs LB, et al. Guidelines pub- lished by organizations or institutions such as the National The American College of Institutes of Health and the American College of Obstetri- Obstetricians and Gynecologists cians and Gynecologists were reviewed, and additional 12th Street, SW studies were located by reviewing bibliographies of identi- PO Box fied articles.
Despite these similarities, the interpretation of our findings should be cautious since, in absence of a referent histopathologist with specific training in GTD diagnosis, strict differentiation between both could be uncertain. Choose one of the access methods below or take a look at our subscribe or free trial options. In Morocco, little research has been conducted on GTD and the few studies published raised alarming concerns regarding late diagnosis, irregular surveillance, frequent drop-out, and common delayed diagnosis of preventable complications [ 67 ].
For any urgent enquiries please contact our customer services team who are ready to help with any problems. Am J Obstet Gynecol phoblastic disease. Such false-positive test results, also known as site trophoblastic tumor, can follow any pregnancy. Their prognosis is generally good but relies on accurate diagnosis, adequate treatment, and thorough posttreatment surveillance for early diagnosis of complications.
Utility of commonly used com- —9; discussion — This observation supports the necessity to include a patient-specific approach to GTD management programs in similar contexts, taking into account the characteristics of the population targeted and their specific IEC needs.
Log In Sign Up. All 50 cases were thoroughly documented and their management was approved according to the adopted guidelines. Indeed, since most spontaneous miscarriages and vacuum aspiration products for pregnancy loss are not systematically submitted for histopathological analysis due to cost constraints, the real incidence of GTD in the region remains difficult to establish, and the abovementioned numbers are probably underestimates.
Please enter a valid username and password and try again. Although rare instances of long latent periods hCG determinations and instituting chemotherapy only in have been reported, most episodes of malignant sequelae patients with postmolar gestational trophoblastic disease after hydatidiform moles occur within approximately outweighs the potential risk and small benefit of routine 6 months of evacuation 2, 3.
Placental site trophoblastic tumor: Take a look at our subscription options. Principals and practice of gynecologic oncolo- Primary remission rates of patients treated with a variety gy, 2nd ed. The findings of our study suggest the need to investigate possibilities of implementing routine first-trimester ultrasound scan, at least for populations gesational risk, which could be determined according to our local context and capacities.
It seems that there are multiple environmental factors involved in increased GTD risk, but further research is necessary to affirm their exact role in generating or favoring the genesis of GTD. Level III Gynecol ; Postmolar trophoblastic disease tional 6 months 4. Among surgery for presumed malignant gestational trophoblastic patients with co-existent moles and fetuses who continue disease.
The ical, photocopying, tropholastic, or otherwise, without prior writ- search was restricted to articles published in the English ten permission from the publisher. II-2 Evidence obtained from well-designed cohort or case—control analytic trophooblastic, preferably from more than 1 center or research group. We will respond to all feedback.
Diagnosis and treatment of gestational trophoblastic disease: ACOG Practice Bulletin No. 53
Before the advent of sensitive assays for human chorionic gonadotropin hCG and efficacious chemotherapy, the morbidity and mortality from gestational trophoblastic disease were substantial.
After molar only in patients with postmolar gestational tropho- evacuation, all patients should be monitored with blastic disease outweighs the potential risk and serial hCG determinations to diagnose and treat small benefit of routine prophylactic chemotherapy malignant sequelae promptly.
The role of opera- tion in the current therapy of gestational trophoblas- In the neighboring Great Casablanca region, Boufettal et al. Obstet Gynecol ; treatment with chemotherapy. Both complete trophoblastic disease was lower in patients using oral and partial tropboblastic with co-existent fetuses have been contraceptives Several models highlight how these perceptions and beliefs become a key element of psychological adaptation of patients to their condition and adherence to the therapeutic project [ 3435 ].
Gestational trophoblastic trophoblastic disease. The management of gestational trophoblastic tumors phoblastic Disease Center Cancer ; Summary of Recommendations The following recommendations are based primar- ily on consensus and expert opinion Level C: