Factores de riesgo de la enfermedad trofoblástica gestacional: Hospital Central Universitario Dr. Antonio María Pineda / Risk factors of gestational trofoblastic disease: Hospital Central Universitario Dr. Antonio María Pineda

La Enfermedad Trofoblástica Gestacional (ETG) es una patología de la primera mitad del embarazo caracterizada por una degeneración hidrópica de las vellosidades coriales que abarca la placenta y el resto del complejo ovular; es generalmente benigna pero puede malignizarse y distribuirse hacia otros tejidos. Se realizó un estudio descriptivo transversal con recolección retrospectiva de datos cuyo objetivo fue determinar los factores de riesgo de la ETG en pacientes que acudieron al Servicio de Emergencia Gineco-Obstétrica del Hospital Dr. Antonio María Pineda durante el período enero-agosto 2018. Dentro de la muestra se incluyeron las historias clínicas de 55 pacientes siendo la mayor parte mujeres menores de 28 años, de procedencia urbana, multigestas, sin antecedentes de aborto espontáneo o embarazo molar y sin uso de dispositivos intrauterinos o uso prolongado de anticonceptivas orales. En conclusión, se hace necesario un mayor seguimiento a mujeres embarazadas jóvenes con las características anteriormente expuestas con la finalidad de realizar un diagnóstico temprano de la enfermedad y de esta manera implementar medidas que garanticen su salud y vida(AU)

Gestational Trophoblastic Disease (TSG) is a pathology of the first half of pregnancy characterized by a hydropic degeneration of the chorionic villi that spans the placenta and the rest of the ovular complex; it is usually benign, but it can become malignant and spread to other tissues. A descriptive transversal study with retrospective review of medical charts was performed in order to determine the risk factors for TSG of patients evaluated at the Servicio de Emergencia Gineco-Obstétrica of the Hospital Dr. Antonio Maria Pineda during the January-August 2018 period. Fifty-five medical charts were reviewed. Results show that TSG was more common in women < 28 years old that lived in urban areas, which had several pregnancies, with no prior history of spontaneous abortion, molar pregnancy, use of intrauterine devices or prolonged use of contraceptive pills. In conclusion, a follow-up of young pregnant women is necessary in order to have an on time diagnosis of this disease as well as promote measures that guarantee the patients' health as well as her life(AU)

Thyroid function among women with gestational trophoblastic diseases. A cross-sectional study

ABSTRACT BACKGROUND: Gestational trophoblastic diseases (GTDs) are treatable rare tumors with wide distribution. The estimated incidence of GTDs varies dramatically between different regions globally. In early pregnancy, there may be high human chorionic gonadotropin (HCG) concentrations, normal or slightly increased free T4 (fT4) and subnormal thyroid-stimulating hormone (TSH), causing hyperthyroidism ranging from subclinical to severe. Beta-HCG causes thyrotoxicosis through thyroid stimulation in patients with trophoblastic tumors. OBJECTIVE: To assess thyroid function among patients diagnosed with complete or partial hydatidiform mole, within the GTD spectrum. DESIGN AND SETTING: Cross-sectional study based on patients' medical records at Van University Hospital, Van, Turkey. METHODS: 50 patients monitored due to diagnoses of hydatidiform mole were included and were examined regarding thyroid function. Thyroid gland size and volume were measured using thyroid ultrasonography. Beta-HCG, TSH, fT4, free T3 (fT3), total T4 (TT4), total T3 (TT3), anti-thyroid peroxidase (anti-TPO), anti-thyroglobulin (anti-TG) and thyroglobulin levels were measured. RESULTS: Among these patients, 15 (30%) were diagnosed with complete hydatidiform mole and 35 (70%) with partial hydatidiform mole, according to pathology results. Those with complete hydatidiform mole were older (P = 0.003), with higher number of pregnancies (P = 0.032), lower TSH level (P = 0.011) and higher fT4 and TT4 levels (P = 0.04; P = 0.028), compared with partial hydatidiform mole patients. CONCLUSION: In hydatidiform mole patients, thyroid disease severity increases with age, parity, beta-HCG level and mole size. However, prospective multicenter studies on this topic are needed, with larger numbers of patients and closer monitoring.

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.

Characterization and functional capacity in women with breast cancer, gynaecological cancer and gestational trophoblastic disease / Caracterización y capacidad funcional de mujeres con cáncer mamario, cáncer ginecológico y enfermedad trofoblástica gestacional / Caracterização e capacidade funcional de mulheres com câncer ginecológico, câncer mamário e doença trofoblástica gestacional

Objective: to describe the social, demographic and clinical profile, and functional capacity of women diagnosed with gynecological cancer, breast cancer and gestational trophoblastic disease during chemotherapy. Method: longitudinal retrospective study that evaluated the records of women treated in hospital clinics from January 2000 to December 2012. Results: they evaluated the records of 438 women. The analysis showed that were not able to perform their daily activities, limited to the activities of self-care. Older patients had greater functional impairment during therapy. Conclusions: the sample was women 41 to 50 years, diagnosed with breast cancer (50.9%) and made use of anthracycline based protocols (47%); the scores of the functional capacity of the sample fell from 78.22 to 73.57. It is evident that nursing care should focus on the control of signs and symptoms that impact the functional capacity of women under chemotherapy.

Objetivo: describir el perfil socio demográfico, clínico y capacidad funcional de mujeres diagnosticadas con cáncer ginecológico, mamario y enfermedad trofoblástica gestacional en tratamiento quimioterápico. Método: estudio longitudinal retrospectivo, que evaluó los registros de mujeres en tratamiento en un hospital de clínicas en el período de enero/2000-diciembre/2012. Resultados: fueron evaluados los registros de 438 mujeres. El análisis mostró que las pacientes no eran capaces de realizar sus actividades cotidianas, limitándose a las actividades del autocuidado. Las pacientes mayores sufrieron más comprometimiento funcional durante la terapéutica. Conclusiones: la muestra estudiada era de mujeres con 41-50 años, diagnosticadas con cáncer de mama (50,9%) y hacían uso de protocolos basados en antracíclicos (47%); los escores de la capacidad funcional de la muestra decayeron de 78,22 para 73,57. Se evidencia que los cuidados de enfermería deben centrarse en el control de señales y síntomas que causan impacto en la capacidad funcional de las mujeres en quimioterapia.

Objetivo: descrever o perfil sociodemográfico e clínico e a capacidade funcional de mulheres diagnosticadas com câncer ginecológico, câncer mamário e doença trofoblástica gestacional em tratamento quimioterápico. Método: estudo longitudinal retrospectivo, que avaliou os registros de mulheres em tratamento em um hospital de clínicas no período de janeiro de 2000 a dezembro de 2012. Resultados: foram avaliados os registros de 438 mulheres. A análise mostrou que as pacientes não eram capazes de realizar suas atividades cotidianas, limitando-se àquelas do autocuidado. As pacientes idosas sofreram maior comprometimento funcional durante a terapêutica. Conclusões: a amostra estudada era de mulheres com 41 a 50 anos, diagnosticadas com câncer de mama (50,9%), que faziam uso de protocolos baseados em antracíclicos (47%); os escores da capacidade funcional da amostra decaíram de 78,22 para 73,57. Evidencia-se que os cuidados de enfermagem devem centrar-se no controle de sinais e sintomas que causam impacto na capacidade funcional das mulheres sob quimioterapia.