Clinical Features of Gestational Trophoblastic Disease in Aged Women in South Vietnam.

PURPOSE: This study aimed to determine the occurrence rate of gestational trophoblastic neoplasia (GTN) and its related factors in aged women with hydatidiform mole (HM) in Tu Du Hospital, Vietnam. MATERIALS AND METHODS: This retrospective cohort study included 372 women aged ≥40 years with HM diagnosed through post-abortion histopathological assessment in Tu Du Hospital from January 2016 to March 2019. Survival analysis was used for GTN cumulative rate estimation, log-rank test for group comparison, and Cox regression model for determining GTN-related factors. RESULTS: After a 2-year follow-up, 123 patients were found to have GTN at a rate of 33.06% [95% confidence interval (CI): 28.30-38.10]. GTN occurrence meant that the time was 4.15±2.93 weeks with peaks at week 2 and 3 after curettage abortion. The GTN rate was remarkably higher in the ≥46-year age group than in the 40-to-45-year age group [hazard ratio (HR)=1.63; 95%CI: 1.09-2.44], as was the vaginal bleeding group compared to the non-bleeding group (HR=1.85; 95%CI: 1.16-2.96). Preventive hysterectomy and preventive chemotherapy plus hysterectomy in the intervention group reduced the GTN risk compared to the no intervention group at HRs of 0.16 (95%CI: 0.09-0.30) and 0.09 (95%CI: 0.04-0.21), respectively. Chemoprophylaxis failed to decrease the GTN risk when comparing the two groups. CONCLUSION: Post-molar pregnancy GTN rate in aged patients was 33.06%, much higher than that of the general population. Preventive hysterectomy or chemoprophylaxis plus hysterectomy are effective treatment methods to support GTN risk reduction.

Value of Crossover Sign in Anticipating Under-8-week Cesarean Scar Pregnancy Treatment by Foley Insertion Combined with Suction Curettage in Vietnam.

OBJECTIVES: An earlier study completed at TuDu Hospital presented the efficacy of Foley insertion combined with fetal suction curettage at a high rate of success in treatment of cesarean scar pregnancy (CSP) of < 8 weeks, but the efficacy of prognosticating factors for this approach has not been specifically addressed yet, especially crossover sign (COS) on ultrasound. We aimed to investigate the correlation between COS on ultrasound and the treatment results of CSP using Foley insertion combined with fetal suction. MATERIALS AND METHODS: A case-control study of CSPs ≤ 8 weeks treated at TuDu Hospital during September 2017-April 2019 included 63 failures in the case group and 98 successes in the control group. RESULTS: COS-2 + increased the likelihood of treatment success by 4.9 times (95% confidence interval: 1.8-13.5) compared with COS-1 cases. In addition, other factors favoring treatment success with statistical significance included no vascularization at cesarean scar on ultrasound (odds ratio [OR] = 7.1), gestational mass volume ≤4 cm3 (OR = 3.7), and ß-human chorionic gonadotropin at hospital admission ≤ 10,000 mIU/mL (OR = 6.1). CONCLUSION: COS imaging played an important role in the prediction of treatment outcomes for CSP ≤ 8 weeks by the combined approach of Foley insertion and fetal suction curettage.

Management of Cesarean Scar Pregnancy among Vietnamese Women.

OBJECTIVE: To demonstrate the efficacy of management for cesarean scar ectopic pregnancies up to 8 weeks' gestation using ultrasound-guided Foley balloon catheter placement combined with dilation and curettage (D and C) at TuDu Hospital. SUBJECTS AND METHODS: A quasi-experimental study was conducted from March 2015 to March 2016. Patients with imaging-confirmed cesarean ectopic pregnancies were admitted to an inpatient unit at Tu Du Hospital. A Foley balloon catheter was placed inside the uterus under ultrasound guidance and was left in place for 24 h. Afterward, the patient underwent ultrasound-guided D and C. Follow-up to confirm success included serial blood draws to measure beta-human chorionic gonadotropin (ß-hCG) levels until a value of 0, and routine ultrasounds to confirm absence of a gestational sac and no evidence of vascularity at the site of the cesarean section scar. RESULTS: A total of 311 patients were enrolled over 3 months. Overall, 90.7% (95% confidence interval [CI]: 86.8%-93.9%) patients were successfully treated with this regimen. Several factors that were significantly associated with successful management included gestational age <6 weeks (odds ratio [OR] 3.1, 95% CI: 1.03%-8.76%), ß-hCG level <11,000 mUI/mL before discharge from the hospital (OR 6.5, 95% CI: 1.42%-30.6%), gestational sac volume 2 weeks after treatment measuring <5 cm3 (OR 9.1, 95% CI: 1.96%-50.1%). CONCLUSIONS: This is an easily applicable method with a short follow-up period and reduction in treatment costs compared to standard treatment with methotrexate injection.

Predictive value of the sFlt-1 and PlGF in women at risk for preeclampsia in the south of Vietnam.

BACKGROUND: It has been suggested that soluble fms-like tyrosine kinase receptor-1 (sFlt-1) and placental growth factor (PlGF) play potential roles in preeclampsia diagnosis. Nevertheless, studies on the use of sFlt-1, PlGF, and sFlt-1/PlGF ratio in predicting preeclampsia have found contradictory results. Thus, more studies in different populations are needed. OBJECTIVES: This study aims to (i) examine the associations between sFlt-1, PlGF, or sFlt-1/PlGF ratio at gestational ages of 24-28 weeks and subsequent preeclampsia, and (ii) estimate predictive values of these markers in southern Vietnamese women. METHODS: We used a nested case-control design from a cohort of 490 pregnant women who were at risk of preeclampsia. The total sample size for statistical analysis consisted of 30 cases and 67controls. Levels of sFlt-1 and PlGF were quantified by using a fully automated electrochemiluminescence immunoassay platform (Elecsys®/Cobas®). RESULTS: The median of sFlt-1 concentration was not statistically different between case and control groups. The median PlGF concentration was lower (349.7 pg/ml versus 534.6 pg/ml, P < .001) and the median sFlt-1/PlGF ratio was higher in the preeclampsia group (4.3 versus 1.9, P < .001). After adjusting for maternal age, gestational age, nullipara, and body mass index, the odds of preeclampsia in women with an sFlt-1/PlGF ratio in the fourth quartile were 10 times greater than in women with an sFlt-1/PlGF ratio in the other quartiles (95% confidence interval, 3.2-31.4; P < .001). CONCLUSIONS: This study contributes to the literature that sFlt-1/PlGF ratio measured at gestational weeks 24-28 in southern Vietnamese women can separate preeclamptic from normotensive cases.