Pregnancy Outcomes of Patients Who Conceived within 1 Year after Chemotherapy for Gestational Trophoblastic Tumor: A Clinical Report of 22 Patients

doi:10.1006/gyno.2001.6170

Gynecologic Oncology

Volume 83, Issue 1, October 2001, Pages 146-148

https://doi.org/10.1006/gyno.2001.6170 Get rights and content

Abstract

Objective. The aim of this study was to explore the risk of pregnancy of patients who conceived within 1 year after successful chemotherapy for gestational trophoblastic tumor (GTT).

Methods. From 1966 to 1996, 22 patients who conceived within 1 year after chemotherapy were followed up and analyzed retrospectively.

Results. Among 22 patients, 9 had term deliveries and 1 had a premature birth, 6 had induced abortion at the patient's request, and 6 had therapeutic abortion because of various indications such as repeated hydatidiform mole (1 case), intrauterine death (1 case), inevitable abortion (1 case), and threatened abortion (3 cases). The fetal loss rate was 27.1% (6/22). The incidence rate of gestational trophoblastic disease (GTD) was 9.1% (2/22). The incidence rate of GTT was 4.5% (1/22). The average interval between completion of chemotherapy and pregnancy was 10.25 months in the group of term pregnancies and 5.86 months in that of fetal loss (P < 0.05), indicating that the longer the interval, the lesser the risk of GTD.

Conclusion. The results suggest that contraception for 1 year is necessary in patients with GTT after successful chemotherapy. However, in the case of a patient who conceives within 1 year, it is not necessary to terminate pregnancy, but the pregnancy must be carefully watched.

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Long-term follow up of pregnancy outcome after successful chemotherapy for gestational trophoblastic tumor
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Cited by (21)

Gestational trophoblastic disease
2012, Best Practice and Research: Clinical Obstetrics and Gynaecology
Citation Excerpt :
The total dosage of methotrexate received by these mothers was also significantly higher compared with the rest, whose children did not have cardiac abnormalities (P < 0.02). Another small study by Lan et al.,58 included 22 women with choriocarcinoma and invasive moles who conceived within 1 year after completing chemotherapy. One suspected recurrence of GTN and another repeated hydatidiform mole were reported, and the fetal loss rate was 27.1% (6 out of 22).
Most women with gestational trophoblastic disease are of reproductive age. Because the disease is readily treatable with favourable prognosis, fertility becomes an important issue. Hydatidiform mole is a relatively benign disease, and most women do not require chemotherapy after uterine evacuation. A single uterine evacuation has no significant effect on future fertility, and pregnancy outcomes in subsequent pregnancies are comparable to that of the general population, despite a slight increased risk of developing molar pregnancy again. If women develop persistent trophoblastic disease, single or combined chemotherapy will be needed. Although ovarian dysfunction after chemotherapy is a theoretical risk, a term live birth rate of higher than 70% has been reported without increased risk of fetal abnormalities. Successful pregnancies have also been reported after choriocarcinoma. Only a few case reports have been published on fertility-sparing treatment in placental-site trophoblastic tumour, and the successful rate is about 67%. Women are advised to refrain from pregnancy for at least 6 months after a molar pregnancy, and at least 12 months after a gestational trophoblastic neoplasia. Most of the contraceptive methods do not have an adverse effect on the return of fertility. Finally, at least one-half of these women suffer from some form of psychological or sexual problems. Careful counselling and involvement of a multi-disciplinary team are mandated.
Clinicopathologic characteristics and subsequent pregnancy outcome in 139 complete hydatidiform moles
2006, European Journal of Obstetrics and Gynecology and Reproductive Biology
The most common form of gestational trophoblastic disease is the complete hydatidiform mole (CHM). The study reports our experience of clinicopathologic characteristics and subsequent pregnancy outcome of patients with CHM.
One hundred fifty-one subsequent cases with initial diagnosis of CHM were re-evaluated histopathologically. Clinical characteristics, the need for chemotherapy and subsequent pregnancy outcome were evaluated.
Twelve out of 151 cases were re-evaluated as hydropic abortion, as partial hydatidiform moles or were insufficient for morphologic examination and therefore excluded from further analysis. The leading clinical symptoms of the remaining 139 cases were irregular vaginal bleeding (67%) and uterine enlargement (41%). Twenty-six patients (19%) required chemotherapy because of gestational trophoblastic neoplasia (GTN; low-risk: 23 out of 26). All patients were cured successfully. The subsequent pregnancy rate was 15% (21/139). Five patients suffered from abortions, 12 women delivered a healthy offspring. Four women presented with recurrent CHM with a spontaneous normalization of HCG levels after D&C.
The clinical and morphologic diagnosis of CHM is a challenge, and diagnosis as well as treatment should be multidisciplinary and centralised. One fifth of CHM are at risk of a GTN, but the cure rate is 100% with adequate management. Pregnancy outcome following CHM is complicated by an increased risk of abortion.
Experience in treatment of patients with gestational trophoblastic disease
2005, Taiwanese Journal of Obstetrics and Gynecology
To determine outcome in patients with hydatidiform mole and gestational trophoblastic tumor after successful treatment.
This was a retrospective review of outcome in 22 patients with gestational trophoblastic disease (GTD) who completed human chorionic gonadotropin (hCG) follow-up for 1 year or more after treatment between 1999 and 2003.
The mean age of patients with GTD was 32.5 years. Sixteen patients (72.7%) with hydatidiform mole and six (27.3%) with gestational trophoblastic tumor were evaluated. One patient (4.5%) with metastatic choriocarcinoma experienced complete remission after debulking surgery followed by chemotherapy. Fifteen patients (68.2%) with persistent GTD were diagnosed by hCG follow-up. After at least 1 year, eight patients (36.4%) conceived and six (27.3%) delivered a healthy term baby. All patients experienced an excellent prognostic outcome following chemotherapy and there were no deaths.
GTD exhibited an excellent response to chemotherapy and subsequent successful pregnancy was achieved in some patients 1 year or more after completion of treatment. Patients without previous childbirth desired subsequent pregnancy. Patients must be followed-up carefully after treatment and during conception.
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2019, International Journal of Gynecological Cancer
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Case ReportPregnancy Outcomes of Patients Who Conceived within 1 Year after Chemotherapy for Gestational Trophoblastic Tumor: A Clinical Report of 22 Patients

Abstract

Long-term follow up of pregnancy outcome after successful chemotherapy for gestational trophoblastic tumor

Chinese J Obstet Gynecol

Case Report
Pregnancy Outcomes of Patients Who Conceived within 1 Year after Chemotherapy for Gestational Trophoblastic Tumor: A Clinical Report of 22 Patients