Diagnostic and therapeutic curettage in gestational trophoblastic disease

Schlaerth, John B.; Morrow, C. Paul; Rodriguez, M. Hellen

doi:10.1016/0002-9378(90)90907-o

Cited by 43 publications

(21 citation statements)

References 6 publications

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“…Therefore, they emphasized prioritizing immediate medical treatment in post-molar GTN management. 17 , 18 …”

Section: Introductionmentioning

confidence: 99%

A pilot randomized controlled clinical trial of second uterine curettage versus usual care to determine the effect of re-curettage on patients’ need for chemotherapy among women with low risk, nonmetastatic gestational trophoblastic neoplasm in Urmia, Iran

Ayatollahi¹,

Yekta²,

Afsari³

2017

IJWH

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ObjectiveThe objective of this study was to determine if second curettage was associated with a decreased need for the number of chemotherapy treatments compared to usual care.MethodsA pilot randomized controlled clinical trial was designed at Motahhari Referral Hospital in 2014. Fifty-two patients with low risk, nonmetastatic gestational trophoblastic neoplasm were assigned randomly to two arms. The interventional arm included a repeat uterine curettage, and the control group received standard care (chemotherapy). All participants were followed periodically over 6 months. Primary outcome was defined as the number of chemotherapy courses in each arm. Student’s t-test and receiver operator characteristics (ROC) curve were applied for statistical analysis as appropriate.ResultsFifty percent of participants who underwent re-curettage did respond to intervention with no further chemotherapy after 6 months of follow-up. The intervention arm had higher number of remissions without chemotherapy compared to those who received usual care. In the subgroup analysis, the ROC curve could predict the re-curettage treatment response by beta human chorionic gonadotropin (BhCG) level significantly. No complications were reported in the intervention arm.ConclusionSecond curettage is an alternative effective procedure to decrease the need for chemotherapy among patients with low risk, nonmetastatic gestational trophoblastic neoplasm. Further clinical trials with larger sample size may be needed to determine the effective role of second curettage among patients.

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“…Therefore, they emphasized prioritizing immediate medical treatment in post-molar GTN management. 17 , 18 …”

Section: Introductionmentioning

confidence: 99%

A pilot randomized controlled clinical trial of second uterine curettage versus usual care to determine the effect of re-curettage on patients’ need for chemotherapy among women with low risk, nonmetastatic gestational trophoblastic neoplasm in Urmia, Iran

Ayatollahi¹,

Yekta²,

Afsari³

2017

IJWH

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“…Mungan (9) described 0.6% (two of 310) uterine perforations after curettage for a hydatidiform mole. Schlaerth (10) even reported an incidence of 8.1% (three of 37 patients with GTD) with all patients needing a laparotomy and hysterectomy. One of these three patients had an enlarged uterus (>8 weeks' gestational size).…”

Section: Discussionmentioning

confidence: 99%

A case of a hydatidiform mole in a 56-year-old woman

Lok

Zürcher

Velden

2005

Int J Gynecol Cancer

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A case of a 56-year-old woman with a mole pregnancy and a human chorionic gonadotropin (HCG)-induced thyreotoxicosis is presented. A proper diagnosis was only made after a period of patient and doctor's delay. After performing a hysterectomy, the HCG quickly normalized. Thyroid function normalized with thiamazol treatment. It is well known that older women have a higher risk to develop gestational trophoblastic disease (GTD). Furthermore, the chance of persistent trophoblastic disease is increased in this population. The literature on risk factors for developing persistent GTD and the possibilities for treatment in older patients is reviewed.

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“…Other associated conditions include placenta accreta with an incidence of uterine perforation that may be up to 13.8%, 5 and gestational trophoblastic disease, usually at the time of dilation and curettage, with an incidence of 8.1%. 6 Spontaneous uterine rupture has been reported with placental site trophoblastic tumor, a subtype of gestational trophoblastic disease characterized by neoplastic intermediate trophoblast. 7 Although placental site trophoblastic tumor is almost never diagnosed in association with a viable pregnancy, it has been reported to occur 1 week following premature twin delivery at 21 weeks, 8 and at the time of first trimester abortion when embryonal tissue was identified.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Uterine Rupture and Hemoperitoneum in the First Trimester

Dibbs

Ball²,

Huettner³

1995

Amer J Perinatol

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Uterine rupture, a potentially catastrophic complication during pregnancy, has been reported to occur spontaneously in the second and third trimesters. We describe a case of spontaneous uterine rupture at 8 weeks' gestation in a 29-year-old woman, who has a history of systemic lupus erythematosus. The diagnosis was established with the aid of ultrasound imaging. She underwent local excision of the perforated area of the uterus. Histologic examination revealed exuberant intermediate trophoblast. On follow-up, human chorionic gonadotropin (hCG) titers returned to normal over a 15-week period. We conclude that spontaneous uterine rupture can occur in the first trimester, and early utilization of ultrasound could help in the management of this serious condition.

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Diagnostic and therapeutic curettage in gestational trophoblastic disease

Cited by 43 publications

References 6 publications

A pilot randomized controlled clinical trial of second uterine curettage versus usual care to determine the effect of re-curettage on patients’ need for chemotherapy among women with low risk, nonmetastatic gestational trophoblastic neoplasm in Urmia, Iran

A pilot randomized controlled clinical trial of second uterine curettage versus usual care to determine the effect of re-curettage on patients’ need for chemotherapy among women with low risk, nonmetastatic gestational trophoblastic neoplasm in Urmia, Iran

A case of a hydatidiform mole in a 56-year-old woman

Spontaneous Uterine Rupture and Hemoperitoneum in the First Trimester

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Diagnostic and therapeutic curettage in gestational trophoblastic disease

Cited by 43 publications

References 6 publications

A pilot randomized controlled clinical trial of second uterine curettage versus usual care to determine the effect of re-curettage on patients&rsquo; need for chemotherapy among women with low risk, nonmetastatic gestational trophoblastic neoplasm in Urmia, Iran

A pilot randomized controlled clinical trial of second uterine curettage versus usual care to determine the effect of re-curettage on patients&rsquo; need for chemotherapy among women with low risk, nonmetastatic gestational trophoblastic neoplasm in Urmia, Iran

A case of a hydatidiform mole in a 56-year-old woman

Spontaneous Uterine Rupture and Hemoperitoneum in the First Trimester

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Resources

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A pilot randomized controlled clinical trial of second uterine curettage versus usual care to determine the effect of re-curettage on patients’ need for chemotherapy among women with low risk, nonmetastatic gestational trophoblastic neoplasm in Urmia, Iran

A pilot randomized controlled clinical trial of second uterine curettage versus usual care to determine the effect of re-curettage on patients’ need for chemotherapy among women with low risk, nonmetastatic gestational trophoblastic neoplasm in Urmia, Iran