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(a) principal: | |
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Data de Publicação: | 2018 |
Outros Autores: | , , , , , , , , , , , , , |
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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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 |
|
_version_ |
1808128198128435200 |