Mola hidatiforme parcial del segundo trimestre / Second trimester partial hydatidiform mole

La mola hidatiforme coexistente con un feto vivo es una entidad infrecuente que se caracteriza por la degeneración hidrópica de las vellosidades coriales, hiperplasia del trofoblasto y evidencia macroscópica de un feto. El objetivo del trabajo fue describir el caso clínico de una paciente con diagnóstico de mola parcial y edad gestacional de 23 semanas. Presentamos una paciente de 31 años remitida de consulta de perinatología con 22,5 semanas de gestación, tensión arterial elevada, signo de más y ecografía con 20 semanas que describe placenta con lagos venosos; con antecedentes de alfafetoproteína elevada. En el hospital empeoró su estado con una preeclampsia agravada, y con ecografía evolutiva que describe placenta de 71 mm, con múltiples lagos venosos. Se plantea posible enfermedad trofoblástica y se discute para interrupción del embarazo. Se realizó microcesárea, se obtiene feto muerto femenino de 600 gramos, con placenta de 400 gramos con múltiples vesículas que recuerdan la mola parcial, diagnóstico que se confirma posteriormente con estudio histopatológico. En la mola parcial, el embrión rara vez sobrevive hasta el segundo trimestre. Si no se realizan pruebas citogenéticas, posiblemente no se diagnostiquen porque los cambios histológicos suelen ser sutiles. La clínica, la fracción beta de la gonadotropina coriónica y el estudio de la placenta, el feto o ambos, son los que permitirán realizar el diagnóstico definitivo para determinar el seguimiento y disminuir las complicaciones(AU)

The hydatidiform mole coexisting with a living fetus is a rare entity that is characterized by hydropic degeneration of the chorionic villi, hyperplasia of the trophoblast and macroscopic evidence of a fetus. The objective of the study was to describe the clinical case of a patient with a diagnosis of partial mole and gestational age of 23 weeks. We present a 31-year-old patient referred for perinatology consultation with 22.5 weeks of gestation, high blood pressure, plus sign and ultrasound with 20 weeks describing placenta with venous lakes; and history of high alpha-fetoprotein. In the hospital, her condition worsened with aggravated preeclampsia, and with an evolving ultrasound, that describes a 71 mm placenta with multiple venous lakes. Possible trophoblastic disease arises and is discussed for termination of pregnancy. Micro-cesarean surgery was performed, a female fetus weighing 600 grams was obtained, a placenta of 400 grams with multiple vesicles that resemble partial mole. This diagnosis is later confirmed with histopathological study. In partial mole, the embryo rarely survives until the second trimester. If cytogenetic tests are not performed, they may not be diagnosed because the histological changes are usually subtle. The clinic, the beta fraction of the chorionic gonadotropin and the study of the placenta, the fetus or both, are the ones that will make the definitive diagnosis to determine the follow-up and decrease the complications(AU)

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.

Mola hidatidiforme completa con preeclampsia e hipertiroidismo: presentación clásica / Complete hydatidiform mole with preeclampsia and hyperthyroidism: classic presentation

Introducción: La enfermedad trofoblástica gestacional es un espectro de enfermedades de la placenta, existiendo entre ellas algunas con potencial de invasión y metástasis, dentro de las cuales se incluye la mola invasiva, coriocarcinoma, tumores del sitio de inserción de la placenta y mola hidatidiforme. Esta última a su vez se divide en mola completa y parcial, diferenciándose en histopatología, morfología, cariotipo, malignización y comportamiento clínico, que es el punto al cual nos referiremos en este caso. Caso clínico: mujer de 46 años ingresa por hemoptisis, metrorragia, disnea a pequeños esfuerzos, ortopnea y disnea paroxística nocturna, asociado a hipertensión, taquicardia, masa hipogástrica firme e inmóvil y edema de extremidades. Se realiza ecografía abdominal compatible con MH y bhCG elevada. Evoluciona con crisis hipertensivas, insuficiencia cardiaca congestiva y tirotoxicosis. Inicia trabajo de parto expulsando 665 grs de mola, presentando posteriormente a legrado uterino anemia severa y shock hipovolémico, requiriendo transfusiones y drogas vasoactivas. Se recupera progresivamente con posterior control al alta de bhCG indetectable a los 6 meses. Discusión: Es infrecuenta en la actualidad la presentación clínica clásica de la mola hidatidiforme completa debido al diagnóstico y control precoz del embarazo asociado al uso masivo de la ecografía. Sin embargo es relevante tener un alto grado de sospecha de esta patología debido a sus graves consecuencias, y así realizar una derivación y manejo precoz.

Background: Gestational trophoblastic disease is a spectrum of diseases of the placenta, existing some with potential for invasion and metastasis, among which include invasive mole, choriocarcinoma, tumors of the insertion site of the placenta and hydatidiform mole. The last one is divided into complete and partial mole, differing in histopathology, morphology, karyotype, and clinical malignant behavior, witch is the point we refer to in this case. Case report: 46 year old woman admitted for hemoptysis, metrorrhagia, dyspnea on slight exertion, orthopnea and paroxysmal nocturnal dyspnea associated with hypertension, tachycardia, firm and immovable hypogastric mass and limb edema. Abdominal ultrasound compatible with MH and high BhCG is performed. Evolve with hypertensive crisis, congestive heart failure and thyrotoxicosis. Labor starts driving out 665 grams of mole, after the curettage present hypovolemic shock and severe anemia requiring transfusions and vasoactive drugs. It gradually recovers further control the discharge of BhCG undetectable at 6 months. Discussion: It is currently infrequent classical clinical presentation of complete hydatidiform mole due to early diagnosis and management of pregnancy associated with the widespread use of ultrasound. However it is important to have a high degree of suspicion of this disease because of its serious consequences, and thus make a referral and early management.

Complicações clínicas da gravidez molar / Clinical complications of hydatidiform mole

A gravidez molar, espectro benigno da doença trofoblástica gestacional, representa uma complicação obstétrica da primeira metade da gestação. De maneira geral, cursa com sintomatologia exuberante: hemorragia, útero aumento para a idade gestacional, cistose ovariana e pré-eclâmpsia precoce; chegando mesmo a graves situações clínicas de hipertireoidismo e insuficiência respiratória.Todavia, devido ao diagnóstico precoce da mola hidatiforme, ainda no primeiro trimestre, mercê da ultrassonografia, houve uma importante redução na ocorrência desses sintomas; contribuindo para que a condução desses casos excepcionais ficasse confinada aos Centros de Referência. É objetivo desse artigo apresentar ao obstetra brasileiro uma revisão das complicações clínicas da gravidez molar, atualizando-o no diagnóstico precoce e tratamento dessas condições clínicas que podem ser potencialmente ameaçadoras à vida da gestante e de seu concepto.(AU)

The molar pregnancy, in the benign gestational trophoblastic disease spectrum, represents an obstetric complication of first half of gestation. In general, runs with exuberant symptoms: bleeding, uterus increase for gestational age, ovarian cistose and early preeclampsia; even serious clinical situations of hyperthyroidism and respiratory failure. However, due to the early diagnosis of hydatidiform mole, still in the first trimester, through ultrasound, there was a significant reduction in the occurrence of these symptoms; contributing so that the conduct of these exceptional cases could be confined to the centers of reference. The purpose of this article is to present to the Brazilian obstetrician a review of clinical complications of molar pregnancy, updating it in the early diagnosis and treatment of clinical conditions that can be potentially threatening to the life of the pregnant woman and her fetus.(AU)

Gestação gemelar com mola hidatiforme completa e feto vivo / Twin pregnancy with a complete hydatidiform mole and live fetus

A gestação gemelar com mola hidatiforme completa que coexiste com feto vivo (GGMC) é uma entidade rara. Embora as recomendações sejam de conduta expectante, são descritas diversas complicações maternas e fetais, como o aumento da incidência de abortamento espontâneo, de parto prematuro, de sangramento vaginal, de pré-eclampsia grave e de doença trofoblástica persistente, entre outras complicações. Neste trabalho, descrevemos a evolução clínica de um caso de GGMC que evoluiu para crise tireotóxica, pré-eclâmpsia grave, interrupção da gestação e necessidade de cuidados intensivos maternos. A necropsia fetal evidenciou feto do sexo feminino, sem malformações aparentes, com alterações placentárias que favorecem cromossomopatia. A avaliação dos restos ovulares evidenciou vilosidades com hiperplasia do trofoblasto e vesículas, achados compatíveis com mola hidatiforme completa. Atualmente, após 15 meses de seguimento, a paciente permanece assintomática e com níveis indetectáveis de gonadotrofina coriônica.

Twin pregnancy with complete hydatidiform mole coexisting with a live fetus is a rare entity, and although the recommendations are expectant management of various maternal and fetal complications are described, such as increasing the number of spontaneous abortion, premature delivery, vaginal bleeding, pre-eclampsia and severe persistent trophoblastic disease, among other complications. In this paper, we describe the clinical course of a case of GGMC who developed thyrotoxic crisis, preeclampsia severe, termination of pregnancy and maternal need for intensive care. Fetal autopsy showed a female fetus with no apparent defects; with placental changes favoring chromosomal disorders. The evaluationof ovular remains showed villi with trophoblastic hyperplasia and vesicles, suggestive of complete mole. Currently, after 15 months of follow up, the patient remains asymptomatic with undetectable levels of chorionic gonadotropin.

Impacto da ingestão dietética e do estresse oxidativo em pacientes com doença trofoblástica gestacional / Impact of dietary intake and oxidative stress in patients with gestational trophoblastic disease

A doença trofoblástica gestacional (DTG) é um termo aplicado a um grupo de tumores relacionados à gestação, caracterizando formas benignas (mola hidatiforme - MH) e malignas (neoplasia trofoblástica gestacional - NTG). O estresse oxidativo, a ingestão dietética e o estado nutricional da gestante constituem possíveis fatores de risco para a ocorrência da MH e sua progressão para NTG. A presente revisão tem como objetivo abordar a relação entre essas entidades. Apesar de haver evidências mostrando que a ingestão dietética e o estresse oxidativo possam ter papéis relevantes na etiopatogênese da DTG, ainda são necessários muitos estudos para uma melhor investigação da atuação desses agentes na gravidez molar e suas sequelas malignas e proliferativas.(AU)

The gestational trophoblastic disease (GTD) is a term applied to a rare group of pregnancy related tumors of benign forms (hydatidiform mole - HM) as well as malignant ones (gestational trophoblastic neoplasia - GTN). Oxidative stress, dietetic intake and nutritional status of pregnant women are possible risk factors for the occurrence of HM and its progression to GTN. This review aims to address the relationship between these entities. Besides the evidences supporting that dietetic intake and oxidative stress may have important roles in the GTD etiopathogenesis, many studies are needed to better investigate the role of these agents in molar pregnancy and their proliferative and malignant sequelae.(AU)

Mola hidatiforme completa y feto vivo a término coexistente: reporte de caso / Complete hydatidiform mole and alive fetus to term coexistent. case report

Se presenta el caso de una mola hidatiforme completa y feto vivo a término coexistente en una paciente de 30 años, II gestas I para, con embarazo de 29 semanas y elevación de la presión arterial. La imagen ecográfica al ingreso de la placenta sugirió la presencia de mola hidatiforme junto a un feto normal. Se realizó seguimiento expectante hasta las 37 semanas, cuando presentó un episodio de sangrado genital por lo que se realizó una cesárea y se obtuvo un recién nacido vivo masculino normal, placenta y una tumoración de un tejido vesicular. El examen de anatomía patológica del tejido vesicular reportó mola hidatiforme completa.

A case of complete hydatiform mole with live term coexisting fetus in a 30-year-old patient, II gravida, 1 para, with a pregnancy of 29 weeks and rise of blood pressure is presented. Ultrasound image at admission suggested the presence of hydatiform mole together a live fetus. Patient was followed until 37 weeks, when presented an episode of vaginal bleeding cause a cesarean section was done and a live normal male newborn, placenta and a vesicular tissue tumor were obtained. Pathology exam of vesicular tissue reported complete hydatiform mole.

Crise tireotóxica associada à doença trofoblástica gestacional / Thyrotoxic crisis associated with gestational trophoblastic disease

JUSTIFICATIVA E OBJETIVOS: A gonadotrofina coriônica humana (HCG) e o hormônio tireotrófico (TSH) apresentam analogia entre suas estruturas, assim como seus receptores. Os altos níveis de HCG encontrados nas doenças trofoblásticas gestacionais podem induzir um quadro de hipertireoidismo secundário. O objetivo deste relato é apresentar um caso em que a administração de contraste iodado precipitou um quadro de crise tireotóxica. RELATO DO CASO: Paciente com mola hidatiforme completa foi admitida no centro cirúrgico com sangramento vaginal intenso após realização de tomografia com contraste iodado. Durante indução anestésica, paciente apresentou quadro compatível com crise tireotóxica. CONCLUSÕES: A incidência de quadros graves associados à doença trofoblástica gestacional tende a diminuir com seu diagnóstico precoce. Ainda que isso aconteça, o anestesiologista deve estar atento à possibilidade de crise tireotóxica nesses pacientes.

BACKGROUND AND OBJECTIVES: Human chorionic gonadotropin (HCG) and thyrotrophic hormone (TSH) have analogies in their structures, as well as in their receptors. The high levels of HCG seen in gestational trophoblastic diseases may induce secondary hyperthyroidism. The objective of this report was to present a case in which the administration of iodinated contrast triggered a thyrotoxic crisis. CASE REPORT: Patient with complete hydatidiform mole who was admitted to the operating room with severe vaginal bleeding after a tomographic exam with iodinated contrast. During anesthetic induction, the patient presented symptoms compatible with thyrotoxic crisis. CONCLUSIONS: The incidence of severe presentations associated with gestational trophoblastic disease tends to decrease with early diagnosis. Still, the anesthesiologist should be aware of the possibility of those patients developing thyrotoxic crisis.

JUSTIFICATIVA Y OBJETIVOS: La HCG y el TSH presentan una analogía entre sus estructuras, como también sus receptores. Los altos niveles de HCG encontrados en las enfermedades trofoblásticas de la gestación pueden inducir a un cuadro de hipertiroidismo secundario. El objetivo de este relato es presentar un caso en que la administración de contraste yodado precipitó un cuadro de crisis tirotóxica. RELATO DEL CASO: Paciente con mola hidatiforme completa que entró en quirófano con sangramiento vaginal intenso después de la realización de una tomografía con contraste yodado. Durante la inducción anestésica, la paciente presentó un cuadro compatible con la crisis tirotóxica. CONCLUSIONES: La incidencia de cuadros graves asociados a la enfermedad trofoblástica gestacional tiende a reducirse con su diagnóstico precoz. Pero incluso si eso ocurre, el anestesiólogo debe estar atento a la posibilidad de una crisis tirotóxica en esos pacientes.

Feto con trisomía 18 asociado a mola parcial / Fetus with trisomy 18 associated to partial molar

We present a 38 years old women G2P1A1 who was detected hydramnios; fetal growth restriction, altered Doppler and multiple vesicular forms in the placental structure; at 24 weeks of gestation. A genetic study in amniotic fluid was performed and we determinate a 18 trisomy. The labour begun spontaneously at her´s 32 weeks of gestation, showing us a masculine fetus who had, fenotipically, a small heel malformation. In the macroscopic exam of the placenta, we saw a multicystic form in approximately 15 percent of its structure. The histology demostrated partial molar degeneration and trophoblastic hyperplasia.

Se presenta el caso de una paciente de 38 años, G2P1A1, quien a las 24 semanas de gestación le fue pesquisado un polihidroamnios, asociado a restricción de crecimiento intrauterino, Doppler materno alterado y múltiples imágenes vesiculares en relación a la placenta. Se realizó estudio genético en líquido amniótico que determinó la presencia de una trisomía 18. El trabajo de parto se inicio espontáneamente a las 32 semanas y se obtuvo un producto masculino de 950 gramos, fenotípicamente sólo presentaba leve malformación del talón (talón enpiolet). Al examen macroscópico la placenta presentaba múltiples zonas con vesículas grandes y pequeñas en +/- 15 por ciento de su estructura. El estudio histológico demostró degeneración molar parcial con hiperplasia trofoblástica.

ARDS in a case of vesicular mole with secondary hyperthyroidism.

Vesicular mole is best regarded as a benign neoplasia of the chorion with malignant potentials. In India, the prevalence is one in four hundred pregnancies.We present one such case who presented with thyrotoxicosis and pulmonary edema.

Síndrome da hiperestimulação ovariana como complicação da mola hidatiforme / Ovarian hyperstimulation syndrome as hydatidiform mole complication

A síndrome da hiperestimulação ovariana (SHO) é caracterizada por uma importante transudação de líquido doespaço intravascular para o terceiro espaço. Em geral, ela é uma complicação de técnicas de reprodução assistida. A SHO é um evento extremamente raro em gestações espontâneas e, contrariamente ao que se esperaria, mais raro ainda em gestações molares. Relatamos o caso de uma mulher de 27 anos, com gestação molar de 9 semanas e com ecografia que evidenciava inúmeros cistos tecaluteínicos em ambos os ovários que foi submetida a esvaziamento a vácuo da cavidade uterina e 5 dias após o esvaziamento desenvolveu um quadro de SHO severa. A paciente evoluiu com taquicardia, distensão abdominal, dispnéia, oligúria, derrame pleural e ascite. Ela foi submetida a três paracenteses de alívio e à punção dos cistos tecaluteínicos, guiados por ultra-som. Posteriormente, foi submetida a laparotomia exploradora por suspeita de torção anexial. A paciente ficou internada por 30 dias sendo que uma semana na Unidadede Cuidados Intensivos. Foram necessários dois meses para o desaparecimento dos cistos tecaluteínicos, emboraecograficamente o ovário apresenta-se multifolicular e 5 meses para a regressão completa do BHCG

Hipertiroidismo gestacional: análisis a propósito de un asociado a mola / Gestational hyperthyroidism associated to molar pregnancy: a case report

We report a 18 years old woman that was admitted with a history of four days of cardiac failure with acute pulmonary edema, high blood pressure, left ventricular dilatation and moderate to severe systolic dysfunction. Twenty four hours after admission she had a miscarriage, expelling a mole. The diagnosis of hyperthyroidism caused by a mole and early pre eclampsia was confirmed and the patient was managed with diuretics and dopamine. Symptoms abated, thyroid function tests, cardiac function and size returned to normal values and the patient was discharged asymptomatic, ten days after admission

Hydatidiform mole: a study of 90 cases

To determine the incidence, epidemiology, complications and management of Hydatidiform mole [HM] at the King Fahd Hospital of the University [KFHU]. Al-Khobar, Saudi Arabia. A retrospective study was conducted covering a period of 15 years from.May 1983 to May 1998. There were 90 cases of hydatidiform mole. The details of maternal characteristics, clinical presentation, tumor behavior, management and complication were studied. There were 40,700 deliveries during the study period giving an incidence of hydatidiform mole [HM] of 2.2/1000 deliveries. The most common clinical feature was vaginal bleeding which was noted in 81 [90%] cases. Fifty-six [62%] cases had uterus larger than dates, while in 12 [13%] cases, the uterine size was smaller than dates. Ovarian enlargement was noted in 24 [27%] cases. Complications in the form of hemorrhage occurred in 19 [21%] cases and 9 [10%] cases were complicated by cated by sepsis. The complications were more common in patients presenting late to the hospital. There were 6 [6.7%] cases of invasive mole and 3 [3.3%] cases of choriocarcinoma during the follow-ups of the study group. On the basis of this study, the incidence of hydatidiform mole is comparable to the incidence in some oriental countries. Earlier diagnosis and treatment of HM will probably result in the decrease of complications found in this study

A case of membranoproliferative glomerulonephritis associated with a hydatidiform mole

We treated a 54-year-old woman who was suffering from membranoproliferative glomerulonephritis associated with a complete type of hydatidiform mole. The renal manifestations were proteinuria and hematuria. A renal biopsy, performed before gynecologic management, disclosed focal and segmental subendothelial deposits with a proliferation of the mesangial cell and showed irregularly thickened capillary loops by light and electronmicroscoy. Genralized edema, proteinuria and hematuria were completely recovered by suction and curettage of the hydatidiform mole with prophylactic chemotherapy. The clinical manifestation of earlier presented 3 cases have been the nephrotic syndrome. The common feature of them was a complete remission of the nephropathy after the removal of the hydatidiform mole. The relationship between the hydatidiform mole and glomerulonephritis remains unresolved at present. But we concluded that the hydatidiform mole might be a cause of glomerulonephritis in this case.

Molar pregnancy--associated ectopic decidua: report of a case and review of the literature.

Ectopic or extrauterine decidual transformation is regularly associated with pregnancy. This phenomenon has been observed most often in the ovary and cervix. Sporadic reports have documented decidua formation of peritoneal surfaces, lymph nodes and other organs in pelvic and abdominal cavity. Molar pregnancy-associated ectopic decidua has never been documented. We report the case of ectopic decidua at posterior surface of uterus, near the cul de sac, in a 45-year-old woman with molar pregnancy. The article review reveals that it is the first report of molar pregnancy-associated ectopic decidua.

Lack of association of gestational trophoblastic diseases (GTD) with syphilis and AIDS.

The association between human immunodeficiency virus (HIV) infection and syphilis infection as an etiological factor in Gestational Trophoblastic Disease (GTD) was investigated by means of micro-enzyme linked immunosorbent assay (Micro-ELISA) and Treposcreen-Rapid Plasma Reagin Card Test in 138 sera from patients with Gestational Trophoblastic Disease. We have found only one sample to be positive for HIV infection and one for VDRL. These findings suggest a lack of an etiologic role for the HIV and Syphilis infection in GTD.

Coriocarcinoma de ovario: reporte de un caso

Se presenta el caso de una niña de 10 años, paciente del Hospital Provincial Cotopaxi, que ingresa con cuadro caracterizado por sangrado genital de 20 días de evolución, utero leñoso y doloroso, la pacientes había sido objeto de una violación, 5 meses antes de su ingreso. Luego de ecografía pélvica se determina diagnostico de mola hidatiforme, por lo que se intenta evacuarla por medio de una aspiración endouterina. Al no conseguir el vaciamiento completo del contenido uterino se laparotomiza a la paciente, encontrandose una masa tumoral dependiendo de ovario derecho, la misma que se extrae, Luego del análisis histopatológico se establece la existencia de un coriocarcinoma.

Analysis of risk factors for postmolar trophoblastic disease: categorization of risk factors and effect of prophylactic chemotherapy

Early identification of high risk molar pregnancy is important in preventing the development of subsequent postmolar trophoblastic disease (PMTD). In the present study, evaluation of risk factors of developing PMTD, and indications for initiating prophylactic chemotherapy, and investigation of the effects of prophylactic chemotherapy were undertaken. One hundred and forty complete molar pregnancies treated at Yonsei University College of Medicine were retrospectively analyzed. Thirty-six cases of PMTD developed in these molar pregnancies during follow-up. Risk factors for PMTD were ranked according to frequency with which they were associated with PMTD. The patients with no risk factors were classified in the low-risk group, with one or two in the medium-risk group, and with three or more in the high-risk group. Prophylactic chemotherapy was administered to 14 of 52 low-risk, to 21 of 46 medium-risk, and to 17 of 42 high-risk patients. Among the high-risk patients, the time required for remission was significantly shorter in the group with prophylactic chemotherapy (13.5 weeks) than in the group without prophylactic chemotherapy (22.4 weeks). There were no differences in the duration until remission among the low- and medium-risk patients. Of the 52 patients who received prophylactic chemotherapy, 8 (15.4%) developed PMTD. Among the high-risk patients the occurrence of PMTD was significantly lower in the prophylactic chemotherapy group. Among the low-risk and medium-risk patients, there were no differences in the occurrence of PMTD between the chemoprophylaxis treated and untreated groups. Our results strongly support the use of prophylactic chemotherapy for patients that were designed under our high risk criteria. Prophylactic chemotherapy helps to prevent or reduce the risk of developing PMTD, and shorten the time required for complete remission in high-risk patients.

Insuficiência respiratória aguda após esvaziamento de mola hidatiforme / acute respiratory failure after the evacuation of hydatiform mole

Paciente de 31 anos apresentou insuficiência respiratória aguda após esvaziamento de mola hidatiforme através de curetagem uterina. Manifestaçöes cardiopulmonares acompanham a doença trofoblástica gestacional em incidência de até 11 por cento, podendo decorrer de embolizaçäo de tecido trofoblástico ou de edema pulmonar. A presença de sintomas pulmonares, além de implicaçöes terapêuticas, relaciona-se com o prognóstico da patologia, tornando-se importante o seu reconhecimento.