Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study

OBJECTIVES: Doppler ultrasonography can be used to assess neoangiogenesis, a characteristic feature of postmolar gestational trophoblastic neoplasia. However, there is limited information on whether uterine artery Doppler flow velocimetry parameters can predict gestational trophoblastic neoplasia following a complete hydatidiform mole. The purpose of this study was as follows: 1) to compare uterine blood flow before and after complete mole evacuation between women who developed postmolar gestational trophoblastic neoplasia and those who achieved spontaneous remission, 2) to assess the usefulness of uterine Doppler parameters as predictors of postmolar gestational trophoblastic neoplasia and to determine the best parameters and cutoff values for predicting postmolar gestational trophoblastic neoplasia. METHODS: This prospective cohort study included 246 patients with a complete mole who were treated at three different trophoblastic diseases centers between 2013 and 2014. The pulsatility index, resistivity index, and systolic/diastolic ratio were measured by Doppler flow velocimetry before and 4-6 weeks after molar evacuation. Statistical analysis was performed using Wilcoxon’s test, logistic regression, and ROC analysis. RESULTS: No differences in pre- and post-evacuation Doppler measurements were observed in patients who developed postmolar gestational trophoblastic neoplasia. In those with spontaneous remission, the pulsatility index and systolic/diastolic ratio were increased after evacuation. The pre- and post-evacuation pulsatility indices were significantly lower in patients with gestational trophoblastic neoplasia (odds ratio of 13.9-30.5). A pre-evacuation pulsatility index ≤1.38 (77% sensitivity and 82% specificity) and post-evacuation pulsatility index ≤1.77 (79% sensitivity and 86% specificity) were significantly predictive of gestational trophoblastic neoplasia. CONCLUSIONS: Uterine Doppler flow velocimetry measurements, particularly pre- and post-molar evacuation pulsatility indices, can be useful for predicting postmolar gestational trophoblastic neoplasia.

Colapso materno - Conduta da parada cardíaca na gravidez / Maternal collapse - Management of cardiac arrested in pregnancy

Colapso materno é evento incomum, pouco estudado, porém ameaça de modo iminente a vida da gestante e de seu concepto. Envolve diferentes etiologias e exige intervenção médica imediata, cujo sucesso será o principal definidor do prognóstico da paciente. Sendo assim, é indispensável o domínio do obstetra nas intervenções arroladas nesse evento, tais como: reanimação cardiopulmonar na grávida, cesárea perimortem e cuidados pós-parada cardíaca. Este artigo tem por objetivo atualizar, à luz da evidência científica, as condutas preconizadas em gestantes em colapso, agregando conhecimentos desde as interferências causadas pelas alterações fisiológicas da gravidez até as condutas de suporte básico e avançado de vida nas gestantes

Maternal collapse is an uncommon and poorly researched disorder, but it is so imminent threat to life the expectant mother and her fetus. It involves different etiologies and immediate medical intervention is the main factor guiding the patients' prognostics. As a result, the obstetrician's full grasp over the necessary interventions, such as cardiopulmonary resuscitation during pregnancy, perimortem cesarean section and meticulous care after cardiac arrest, is crucial. The objective of this article is to update, according to recent scientific findings, the best practices in treating maternal collapse, from the analysis of the physiologic modifications caused by pregnancy to basic and advanced life support