Pregnancy outcomes after chemotherapy for trophoblastic neoplasia

Abstract

SUMMARY Introduction The successful development of chemotherapy enabled a fertilitysparing treatment for patients with trophoblastic neoplasia. After disease remission, the outcome of a subsequent pregnancy becomes a great concern for these women. Objective To analyze existing studies in the literature that describe the reproductive outcomes of patients with trophoblastic neoplasia treated with chemotherapy. Method Systematic review was performed searching for articles on Medline/ Pubmed, Lilacs and Cochrane Library databases, using the terms “gestational trophoblastic disease” and “pregnancy outcome”. Results A total of 18 articles were included. No evidence of decreased fertility after chemotherapy for trophoblastic neoplasia was observed. The abortion rates in patients who conceived within 6 months after chemotherapy was higher compared to those who waited longer. Some studies showed increased rates of stillbirth and repeat hydatidiform moles. Only one work showed increased congenital abnormalities. Conclusion The pregnancies conceived after chemotherapy for trophoblastic neoplasia should be followed with clinical surveillance due to higher rates of some pregnancy complications. However, studies in the literature provide reassuring data about reproductive outcomes of these patients.

Fertility and pregnancy outcome in gestational trophoblastic disease

“…A systematic review of 18 articles by Garcia et al in 2016 showed no evidence of decreased fertility after chemotherapy for gestational trophoblastic neoplasia, but a higher miscarriage rate was found in women who conceived within 6 months after chemotherapy compared with women who waited longer. 69 Also, older reports warn against pregnancy within a year after the end of multi-chemotherapy for gestational trophoblastic neoplasia because of a higher risk of recurrence of gestational trophoblastic disease (9.1%) and fetal wastage (27.3%). 70 Fertility and Reproductive Outcomes After Surgery in Highrisk Gestational Trophoblastic Neoplasia Surgery can be an important part of the treatment of high-risk gestational trophoblastic neoplasia.…”

Ectopic Hydatidiform Mole a Case Report

“…MRI can provide a valuable tool for diagnosing ectopic hydatidiform moles through features like, intratumoral hypervascularity, molar tissue-like tiny cystic lesions and dense enhancement as cited in a previous study [9].Outcomes post laparoscopic salpingectomy for ectopic molar pregnancy are good, although the risk quantification for persistent disease after surgical removal is difficult due to scarcity of reported cases, In the previously described choriocarcinoma and invasive mole, chemotherapy was the treatment of choice [10]. About 5% and 15% of patients who are diagnosed with partial mole and complete mole, respectively, will acquire persistent gestational trophoblastic disease [7]. Proper differentiation between molar ectopic and non molar ectopic is hence mandatory.…”

“…Ectopic molar pregnancy was reported in the U.K at a rate of 1.5 in a 1000,000 [6]. Clinical symptoms, ultrasound imaging, quantitative BHCG level are salient aspects that aid the diagnosis of molar pregnancy [7]. It is noteworthy that BHCG levels in tubal molar pregnancy mimics that of an ectopic pregnancy, unlike the high values found in an intrauterine molar pregnancy [8].…”

Gestational Trophoblastic Neoplasia: A Tunisian Multicenter Study

“…The number of studies in the literature regarding this theme is small. The studies highlight that there is no change in fertility [18]. Under close monitoring, patients may conceive six months after achieving complete response [19].…”