Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 8 de 8
Filtrar
1.
J Reprod Med ; 61(5-6): 210-4, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27424360

RESUMO

OBJECTIVE: To investigate the frequency of potentially life-threatening conditions (PLTCs) and maternal near misses (MNMs) at the New England Trophoblastic Disease Center (NETDC) in recent years, when there has been earlier diagnosis of molar pregnancy. STUDY DESIGN: This study included patients with molar pregnancy at the NETDC between 1994 and 2013. Clinical and pathologic reports were reviewed. PLTC and MNM criteria and maternal deaths were searched in medical records using the World Health Organization criteria and classification. RESULTS: We identified 375 patients with molar pregnancy and no patient developed a MNM or maternal death. Only 6 (1.6%) had PLTCs (hemorrhage with hemodynamic instability, severe preeclampsia, respiratory distress, blood transfusion, and ICU admission). CONCLUSION: We observed a low rate of PLTC and no cases of MNMs or maternal deaths related to molar pregnancy, likely due to earlier diagnosis at the NETDC in recent years.


Assuntos
Mola Hidatiforme/epidemiologia , Morte Materna/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Pré-Eclâmpsia/epidemiologia , Hemorragia Uterina/epidemiologia , Neoplasias Uterinas/epidemiologia , Adolescente , Adulto , Transfusão de Sangue/estatística & dados numéricos , Feminino , Doença Trofoblástica Gestacional/epidemiologia , Doença Trofoblástica Gestacional/mortalidade , Humanos , Mola Hidatiforme/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , New England , Gravidez , Síndrome do Desconforto Respiratório/epidemiologia , Estudos Retrospectivos , Neoplasias Uterinas/mortalidade , Organização Mundial da Saúde , Adulto Jovem
2.
Int J Gynecol Cancer ; 26(2): 367-70, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26588240

RESUMO

OBJECTIVE: The aim of this study was to compare the clinical presentation and incidence of postmolar gestational trophoblastic neoplasia (GTN) among cases of complete mole (CM) and partial mole (PM) from 1994 to 2013. METHODS: This study included all cases of patients with CM and PM from our trophoblastic disease center between 1994 and 2013. Their clinical and pathologic reports were reviewed. Gestational age at evacuation, features of clinical presentation, human chorionic gonadotropin levels, and the rate of progression to GTN were compared. RESULTS: The median gestational age at evacuation was 9 weeks for CM and 12 weeks for PM (P < 0.001). Patients with PM had lower pre-evacuation serum human chorionic gonadotropin levels (P < 0.001), and they were also less likely to present with vaginal bleeding (P < 0.001), biochemical hyperthyroidism (P < 0.001), anemia (P < 0.001), uterine size greater than dates (P < 0.001), and hyperemesis (P = 0.002). Consequently, patients with PM were less likely to have been clinically diagnosed as moles compared with CM prior to uterine evacuation (P < 0.001). The development of GTN occurred in 17.7% (33/186) and 4.1% (7/169) of patients with CM and PM, respectively (P < 0.001). CONCLUSIONS: This study indicates that, at our center over the past 20 years, both CM and PM were usually evacuated in the first trimester of pregnancy. Because CM more commonly presents with the signs and symptoms of molar disease than PM, CM is more commonly diagnosed prior to evacuation.


Assuntos
Doença Trofoblástica Gestacional/epidemiologia , Neoplasias Uterinas/epidemiologia , Adulto , Feminino , Humanos , New England/epidemiologia , Gravidez , Adulto Jovem
3.
J Womens Health (Larchmt) ; 24(7): 608-15, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26173000

RESUMO

BACKGROUND: Patient navigators have been used successfully to guide vulnerable patients through barriers to cancer care and reduce disparities in cancer outcomes. This study evaluated the effect of a patient navigator program on no-show rates at a tertiary care referral colposcopy center and explored factors associated with missed appointments. METHODS: No-show rates prior and subsequent to implementation of the intervention were compared by chi-square test. We compared patient demographic, lifestyle, and diagnostic characteristics between patients who had ever and never missed appointments. We described patient-reported barriers to care. RESULTS: Of 4,199 women evaluated in our clinic from January 2006 to December 2013, 2,441 (58%) had at least one missed appointment. African American, Hispanic, and publicly insured women tended to miss appointments more frequently than did white and privately insured women (p<0.0001). Patients who missed appointments tended to have more abnormal cytology (p<0.0001), cervical pathology (p=0.007), and vulvar pathology (p=0.001). No-show rates declined from 49.7% to 29.5% after implementation of the patient navigator program (p<0.0001). We found that 45% of patient no-shows were anticipated or a result of patient misunderstanding and could be mediated with targeted education by the patient navigator. CONCLUSIONS: Patient navigator programs at referral centers reduce no-show rates, thus improving patient follow-up, which may reduce disparities in cervical cancer screening and treatment.


Assuntos
Agendamento de Consultas , Colposcopia/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Navegação de Pacientes , Encaminhamento e Consulta/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Negro ou Afro-Americano/psicologia , População Negra/psicologia , Detecção Precoce de Câncer , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hispânico ou Latino/psicologia , Hospitais de Ensino , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Avaliação de Programas e Projetos de Saúde , Fatores Socioeconômicos
4.
Gynecol Oncol ; 138(1): 50-4, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25933681

RESUMO

OBJECTIVE: To evaluate the potential effects of race on clinical characteristics, extent of disease, and response to chemotherapy in women with postmolar low-risk gestational trophoblastic neoplasia (GTN). METHODS: This non-concurrent cohort study was undertaken including patients with FIGO-defined postmolar low-risk GTN treated with comparable doses and schedules of chemotherapy at the New England Trophoblastic Disease Center (NETDC) between 1973 and 2012. Racial groups investigated included whites, African American and Asians. Information on patient characteristics and response to chemotherapy (need for second line chemotherapy, reason for changing to an alternative chemotherapy, number of cycles/regimens, need for combination chemotherapy, and time to hCG remission) was obtained. RESULTS: Of 316 women, 274 (86.7%) were white, 19 (6%) African American, and 23 (7.3%) Asian. African Americans were significantly younger than white and Asian women (p=0.008). Disease presentation, and extent of disease, including antecedent molar histology, median time to persistence, median hCG level at persistence, rate of D&C at persistence, presence of metastatic disease, and FIGO stage and risk score were similar among races. Need for second line chemotherapy (p=0.023), and median number of regimens (p=0.035) were greater in Asian women than in other races. CONCLUSIONS: Low-risk GTN was more aggressive in Asian women, who were significantly more likely to need second line chemotherapy and a higher number of chemotherapy regimens to achieve complete remission than women of African American and Asian descent. Further studies involving racial differences related to clinical, biological and environmental characteristics are needed.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença Trofoblástica Gestacional/tratamento farmacológico , Doença Trofoblástica Gestacional/etnologia , Adolescente , Adulto , Negro ou Afro-Americano , Asiático , Gonadotropina Coriônica/metabolismo , Ciclofosfamida/administração & dosagem , Dactinomicina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Ácido Fólico/administração & dosagem , Doença Trofoblástica Gestacional/metabolismo , Doença Trofoblástica Gestacional/patologia , Humanos , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Gravidez , Fatores de Risco , População Branca , Adulto Jovem
5.
Gynecol Oncol ; 138(1): 46-9, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25969351

RESUMO

OBJECTIVE: To compare the clinical presentation and incidence of postmolar gestational trophoblastic neoplasia (GTN) among recent (1994-2013) and historical (1988-1993) cases of complete hydatidiform mole (CHM). METHODS: This study included two non-concurrent cohorts (1988-1993 versus 1994-2013) of patients from the New England Trophoblastic Disease Center (NETDC). Clinical and pathologic reports of patients diagnosed with CHM between 1994 and 2013 were reviewed. Gestational age at evacuation, features of clinical presentation, human chorionic gonadotropin (hCG) levels, and the rate of progression to GTN were compared. RESULTS: In the current cohort (1994 to 2013) the median gestational age at diagnosis continued to decline compared to our prior cohort (1988-1993) (9weeks versus 12weeks). Patients from the current cohort were significantly more likely to be diagnosed prior to the 11th week of gestation (56 versus 41%, p=0.04). Patients in the current cohort were also significantly less likely to present with vaginal bleeding (46 versus 84%, p<0.001). Earlier diagnosis of complete mole did not result in a decrease in the rate of postmolar GTN. The frequencies of postmolar GTN in the current (1994-2013) and prior (1988-1993) cohorts were 19 and 23%, respectively. In the current cohort, even diagnosis prior to ten weeks gestation did not decrease the risk of developing GTN. CONCLUSIONS: This study indicates that complete mole continues to be diagnosed progressively earlier resulting in a further decrease in some classical presenting symptoms. However, despite earlier detection, the risk of development of postmolar GTN has not been affected.


Assuntos
Doença Trofoblástica Gestacional/patologia , Mola Hidatiforme/diagnóstico , Adulto , Estudos de Coortes , Detecção Precoce de Câncer , Feminino , Doença Trofoblástica Gestacional/epidemiologia , Humanos , Mola Hidatiforme/epidemiologia , Mola Hidatiforme/patologia , Incidência , New England/epidemiologia , Gravidez , Sistema de Registros , Fatores de Risco , Adulto Jovem
6.
Int J Gynecol Cancer ; 25(4): 734-40, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25675037

RESUMO

OBJECTIVE: Despite rising global obesity rates, the impact of obesity on gestational trophoblastic neoplasia (GTN) remains uninvestigated. This study aimed at investigating whether overweight/obesity relates to response to chemotherapy in low-risk GTN patients. METHODS: This nonconcurrent cohort study included 300 patients with International Federation of Gynecology and Obstetrics-defined postmolar low-risk GTN treated with a single-agent chemotherapy­methotrexate or actinomycin-D (actD)­between 1973 and 2012 at the New England Trophoblastic Disease Center. Chemotherapy dosing was based on actual body weight regardless of obesity status, except for 5-day courses or pulse regimens of actD. Patients were classified as overweight/obese (body mass index [BMI] ≥25 kg/m²) or non-overweight/obese (BMI <25 kg/m²). Information on patient characteristics and response to chemotherapy (need for second-line chemotherapy, reason for changing to an alternative chemotherapy, number of cycles, need for combination chemotherapy, and time to human chorionic gonadotropin remission) was obtained. RESULTS: Of 300 low-risk GTN patients, 81 (27%) were overweight/obese. Overweight/obese patients were older than the non-overweight/obese patients (median age: 30 vs 28 years, P = 0.004). First-line therapy using actD was more frequent in overweight/obese patients (6.2% vs 1.4%, P = 0.036). Resistance and toxicity were similar between groups. No significant difference in the number of chemotherapy cycles needed for remission or time required to achieve remission was found between groups. CONCLUSIONS: No association between overweight/obesity and low-risk GTN outcomes was found. Current chemotherapy dosing using BMI seems to be appropriate for overweight/obese patients with low-risk GTN.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença Trofoblástica Gestacional/tratamento farmacológico , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Adolescente , Adulto , Gonadotropina Coriônica Humana Subunidade beta/análise , Estudos de Coortes , Ciclofosfamida/administração & dosagem , Dactinomicina/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Doença Trofoblástica Gestacional/patologia , Humanos , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Gravidez , Prognóstico , Indução de Remissão , Vincristina/administração & dosagem , Adulto Jovem
7.
Gynecol Oncol ; 130(2): 312-6, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23707672

RESUMO

OBJECTIVE: The purpose of this study was to identify the clinical factors associated with time to hCG remission among women with low-risk postmolar GTN. METHODS: This study included a non-concurrent cohort of 328 patients diagnosed with low-risk postmolar GTN according to FIGO 2002 criteria. Associations of time to hCG remission with history of prior mole, molar histology, time to persistence, use of D&C at persistence, presence of metastatic disease, FIGO score, hCG values at persistence, type of first line therapy and use of multiagent chemotherapy were investigated with both univariate and multivariate analyses. RESULTS: Overall median time to remission was 46 days. Ten percent of the patients required multi-agent chemotherapy to achieve hCG remission. Multivariate analysis incorporating the variables significant on univariate analysis confirmed that complete molar histology (HR 1.45), metastatic disease (HR 1.66), use of multi-agent therapy (HR 2.00) and FIGO score (HR 1.82) were associated with longer time to remission. There was a linear relationship between FIGO score and time to hCG remission. Each 1-point increment in FIGO score was associated with an average 17-day increase in hCG remission time (95% CI: 12.5-21.6). CONCLUSIONS: Complete mole histology prior to GTN, presence of metastatic disease, use of multi-agent therapy and higher FIGO score were independent factors associated with longer time to hCG remission in low-risk GTN. Identifying the prognostic factors associated with time to remission and effective counseling may help improve treatment planning and reduce anxiety in patients and their families.


Assuntos
Gonadotropina Coriônica/sangue , Doença Trofoblástica Gestacional/patologia , Adolescente , Adulto , Criança , Feminino , Doença Trofoblástica Gestacional/sangue , Doença Trofoblástica Gestacional/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Gravidez , Prognóstico , Risco , Fatores de Tempo
8.
J Reprod Med ; 47(5): 380-6, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12063876

RESUMO

Modern therapy for molar pregnancy and gestational trophoblastic tumors has resulted in high cure rates and preservation of fertility, even in the setting of metastatic disease requiring chemotherapy. Patients and their partners facing future pregnancy after treatment for gestational trophoblastic disease express fear related to risk of disease recurrence and outcome of subsequent pregnancies. Data from the New England Trophoblastic Disease Center on later pregnancies following complete and partial mole as well as persistent gestational trophoblastic tumor show that patients, in general, can anticipate normal subsequent pregnancy outcomes.


Assuntos
Doença Trofoblástica Gestacional/epidemiologia , Recidiva Local de Neoplasia/epidemiologia , Resultado da Gravidez , Neoplasias Uterinas/epidemiologia , Feminino , Doença Trofoblástica Gestacional/complicações , Humanos , Mola Hidatiforme/complicações , Mola Hidatiforme/epidemiologia , Prontuários Médicos , Recidiva Local de Neoplasia/complicações , New England/epidemiologia , Gravidez , Neoplasias Uterinas/complicações
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...