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

Detalhes bibliográficos
Autor(a) principal: Braga, Antonio [UNESP]
Data de Publicação: 2018
Outros Autores: Lima, Lana [UNESP], Parente, Raphael Câmara Medeiros [UNESP], Celeste, Roger Keller [UNESP], Filho, Jorge De Rezende [UNESP], Amim Junior, Joffre [UNESP], Maestá, Izildinha [UNESP], Sun, Sue Yazaki [UNESP], Uberti, Elza [UNESP], Lin, Lawrence [UNESP], Madi, José Mauro [UNESP], Viggiano, Maurício [UNESP], Elias, Kevin M. [UNESP], Horowitz, Neil S. [UNESP], Berkowitz, Ross S. [UNESP]
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNESP
Texto Completo: http://hdl.handle.net/11449/228548
Resumo: 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.
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spelling Management of symptomatic uterine arteriovenous malformations after gestational trophoblastic disease: The Brazilian experience and possible role for depot medroxyprogesterone acetate and tranexamic acid treatmentBrazilDepot medroxyprogesterone acetateGestational trophoblastic diseaseTranexamic acidUterine arteriovenous malformationUterine artery embolizationOBJECTIVE: 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 DiseaseDepartment of Gynecology and Obstetrics Faculty of Medicine Maternity School Perinatal Health of Rio de Janeiro Federal UniversityDepartment of Maternal-Child Faculty of Medicine Antonio Pedro University Hospital Fluminense Federal UniversityDepartment of Preventive and Social Dentistry Federal University of Rio Grande do Sul Sao Paulo State UniversityBotucatu Trophoblastic Disease Center Department of Gynecology and Obstetrics Botucatu Medical School Sao Paulo State UniversityUniversidade Federal de Sao PauloMario Totta Maternity Ward of Irmandade da Santa Casa de Misericordia HospitalSao Paulo Clinics Hospital of the University of Sao PauloCaxias do Sul General Hospital of Caxias do Sul UniversityClinical Hospital of Goias Federal University Division of Gynecologic Oncology Departments of Obstetrics and Gynecology and of Reproductive Biology New England Trophoblastic Disease CenterDivision of Gynecologic Oncology Departments of Obstetrics and Gynecology and of Reproductive Biology New England Trophoblastic Disease CenterBrigham and Women’s Hospital Dana-Farber Cancer Institute Harvard Medical SchoolDepartment of Preventive and Social Dentistry Federal University of Rio Grande do Sul Sao Paulo State UniversityBotucatu Trophoblastic Disease Center Department of Gynecology and Obstetrics Botucatu Medical School Sao Paulo State UniversityBrazilian Association of Gestational Trophoblastic DiseasePerinatal Health of Rio de Janeiro Federal UniversityFluminense Federal UniversityUniversidade Estadual Paulista (UNESP)Universidade Federal de São Paulo (UNIFESP)Mario Totta Maternity Ward of Irmandade da Santa Casa de Misericordia HospitalUniversidade de São Paulo (USP)Caxias do Sul General Hospital of Caxias do Sul UniversityNew England Trophoblastic Disease CenterHarvard Medical SchoolBraga, Antonio [UNESP]Lima, Lana [UNESP]Parente, Raphael Câmara Medeiros [UNESP]Celeste, Roger Keller [UNESP]Filho, Jorge De Rezende [UNESP]Amim Junior, Joffre [UNESP]Maestá, Izildinha [UNESP]Sun, Sue Yazaki [UNESP]Uberti, Elza [UNESP]Lin, Lawrence [UNESP]Madi, José Mauro [UNESP]Viggiano, Maurício [UNESP]Elias, Kevin M. [UNESP]Horowitz, Neil S. [UNESP]Berkowitz, Ross S. [UNESP]2022-04-29T08:27:20Z2022-04-29T08:27:20Z2018-01-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article228-239Journal of Reproductive Medicine, v. 63, n. 3, p. 228-239, 2018.0024-7758http://hdl.handle.net/11449/2285482-s2.0-85048036309Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengJournal of Reproductive Medicineinfo:eu-repo/semantics/openAccess2024-08-16T14:12:51Zoai:repositorio.unesp.br:11449/228548Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-16T14:12:51Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false
dc.title.none.fl_str_mv Management of symptomatic uterine arteriovenous malformations after gestational trophoblastic disease: The Brazilian experience and possible role for depot medroxyprogesterone acetate and tranexamic acid treatment
title Management of symptomatic uterine arteriovenous malformations after gestational trophoblastic disease: The Brazilian experience and possible role for depot medroxyprogesterone acetate and tranexamic acid treatment
spellingShingle Management of symptomatic uterine arteriovenous malformations after gestational trophoblastic disease: The Brazilian experience and possible role for depot medroxyprogesterone acetate and tranexamic acid treatment
Braga, Antonio [UNESP]
Brazil
Depot medroxyprogesterone acetate
Gestational trophoblastic disease
Tranexamic acid
Uterine arteriovenous malformation
Uterine artery embolization
title_short Management of symptomatic uterine arteriovenous malformations after gestational trophoblastic disease: The Brazilian experience and possible role for depot medroxyprogesterone acetate and tranexamic acid treatment
title_full Management of symptomatic uterine arteriovenous malformations after gestational trophoblastic disease: The Brazilian experience and possible role for depot medroxyprogesterone acetate and tranexamic acid treatment
title_fullStr Management of symptomatic uterine arteriovenous malformations after gestational trophoblastic disease: The Brazilian experience and possible role for depot medroxyprogesterone acetate and tranexamic acid treatment
title_full_unstemmed Management of symptomatic uterine arteriovenous malformations after gestational trophoblastic disease: The Brazilian experience and possible role for depot medroxyprogesterone acetate and tranexamic acid treatment
title_sort Management of symptomatic uterine arteriovenous malformations after gestational trophoblastic disease: The Brazilian experience and possible role for depot medroxyprogesterone acetate and tranexamic acid treatment
author Braga, Antonio [UNESP]
author_facet Braga, Antonio [UNESP]
Lima, Lana [UNESP]
Parente, Raphael Câmara Medeiros [UNESP]
Celeste, Roger Keller [UNESP]
Filho, Jorge De Rezende [UNESP]
Amim Junior, Joffre [UNESP]
Maestá, Izildinha [UNESP]
Sun, Sue Yazaki [UNESP]
Uberti, Elza [UNESP]
Lin, Lawrence [UNESP]
Madi, José Mauro [UNESP]
Viggiano, Maurício [UNESP]
Elias, Kevin M. [UNESP]
Horowitz, Neil S. [UNESP]
Berkowitz, Ross S. [UNESP]
author_role author
author2 Lima, Lana [UNESP]
Parente, Raphael Câmara Medeiros [UNESP]
Celeste, Roger Keller [UNESP]
Filho, Jorge De Rezende [UNESP]
Amim Junior, Joffre [UNESP]
Maestá, Izildinha [UNESP]
Sun, Sue Yazaki [UNESP]
Uberti, Elza [UNESP]
Lin, Lawrence [UNESP]
Madi, José Mauro [UNESP]
Viggiano, Maurício [UNESP]
Elias, Kevin M. [UNESP]
Horowitz, Neil S. [UNESP]
Berkowitz, Ross S. [UNESP]
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv 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
dc.contributor.author.fl_str_mv Braga, Antonio [UNESP]
Lima, Lana [UNESP]
Parente, Raphael Câmara Medeiros [UNESP]
Celeste, Roger Keller [UNESP]
Filho, Jorge De Rezende [UNESP]
Amim Junior, Joffre [UNESP]
Maestá, Izildinha [UNESP]
Sun, Sue Yazaki [UNESP]
Uberti, Elza [UNESP]
Lin, Lawrence [UNESP]
Madi, José Mauro [UNESP]
Viggiano, Maurício [UNESP]
Elias, Kevin M. [UNESP]
Horowitz, Neil S. [UNESP]
Berkowitz, Ross S. [UNESP]
dc.subject.por.fl_str_mv Brazil
Depot medroxyprogesterone acetate
Gestational trophoblastic disease
Tranexamic acid
Uterine arteriovenous malformation
Uterine artery embolization
topic Brazil
Depot medroxyprogesterone acetate
Gestational trophoblastic disease
Tranexamic acid
Uterine arteriovenous malformation
Uterine artery embolization
description 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.
publishDate 2018
dc.date.none.fl_str_mv 2018-01-01
2022-04-29T08:27:20Z
2022-04-29T08:27:20Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv Journal of Reproductive Medicine, v. 63, n. 3, p. 228-239, 2018.
0024-7758
http://hdl.handle.net/11449/228548
2-s2.0-85048036309
identifier_str_mv Journal of Reproductive Medicine, v. 63, n. 3, p. 228-239, 2018.
0024-7758
2-s2.0-85048036309
url http://hdl.handle.net/11449/228548
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv Journal of Reproductive Medicine
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 228-239
dc.source.none.fl_str_mv Scopus
reponame:Repositório Institucional da UNESP
instname:Universidade Estadual Paulista (UNESP)
instacron:UNESP
instname_str Universidade Estadual Paulista (UNESP)
instacron_str UNESP
institution UNESP
reponame_str Repositório Institucional da UNESP
collection Repositório Institucional da UNESP
repository.name.fl_str_mv Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)
repository.mail.fl_str_mv
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