Nível sérico de hCG na predição de gestações molares abaixo de 11 semanas de idade gestacional
Data
2022-08-09
Autores
Carvalho, Lucas Ribeiro Borges de 
Orientadores
Sun, Sue Yazaki
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: associar os níveis de hCG sérico como preditor de mola hidatiforme, quando comparado com aborto não molar, para diferentes idades gestacionais, abaixo de 11 semanas de gestação. Secundariamente, objetivou-se descrever características demográficas de mulheres com gestação não evolutiva e correlacionar o valor sérico de hCG com o diagnóstico histopatológico de mola hidatiforme completa e aborto não molar, para cada idade gestacional, abaixo de 11 semanas. Métodos: estudo de coorte retrospectivo colaborativo conduzido no Centro de Referência em Doença Trofoblástica Gestacional do Hospital São Paulo da Universidade Federal de São Paulo e no Centro de Referência em Doença Trofoblástica Gestacional da Maternidade Escola da Universidade Federal do Rio de Janeiro. Foram incluídas pacientes de 12 a 55 anos de idade, atendidas de 1 de Janeiro de 2009 até 31 de Dezembro de 2018, com idade gestacional abaixo de 11 semanas, imagem de ultrassonografia de gestação não evolutiva e nível sérico de hCG pré-esvaziamento disponível. Tais pacientes foram divididas em dois grupos: grupo mola hidatiforme completa e grupo aborto não molar. Os valores séricos de hCG foram comparados, de acordo com a idade gestacional. A análise estatística foi realizada por meio de teste não-paramétrico, com nível de significância de 5% (p<0,05) e software SPSS 21 (IBM software). Resultados: foram incluídas 416 pacientes no estudo, sendo que 79 pacientes compuseram o grupo aborto não-molar e 337 compuseram o grupo mola hidatiforme completa, e o poder de amostra calculado foi superior a 80%. Os dados apresentados nos mostram que o quartil 75 do grupo aborto não-molar é sempre inferior ao quartil 25 do grupo mola hidatiforme completa ((9.721mUI/mL/16.435 mUI/mL (6-7 semanas), 20.229 mUI/mL/64.911 mUI/mL (8-9 semanas) e 29.633mUI/mL/126.278 mUI/mL (10-11 semanas), respectivamente; p<0.001). Conclusão: frente a gestações não evolutivas, o nível de hCG sérico de 6.435 mUI/mL em 6-7 semanas e 64.911 mUI/mL em 8-9 semanas sugere diagnóstico de mola hidatiforme completa, e o esvaziamento uterino imediato deve ser realizado. Tendo em mente que o quartil 75 do grupo aborto não-molar é 29.633 mUI/mL, é possível adotar uma conduta expectante se o nível de hCG sérico é inferior à 30.000 mUI/ml, em 10-11 semanas de gestação.
Objective: The aim of this study was to associate serum hCG levels as a molar predictor, comparing to non-molar miscarriages, to different gestational ages, below 11 weeks of pregnancy. Secondarily, it was aimed to describe demographic characteristics of women with non evolutive pregnancies and correlate the serum hCG level with histopathological diagnosis of complete hydatidiform mole and nonmolar pregnancy, for each gestation age, below 11 weeks of pregnancy. Methods: This was a retrospective collaborative cohort study conducted at the São Paulo Hospital Trophoblastic Disease Center of São Paulo Federal University and at the Maternity Hospital Trophoblastic Disease Center of Rio de Janeiro Federal University. Patients from 12 to 55 years, assisted from January 1st 2009 to December 31rd 2018, with a gestational age lower than 11 weeks, an ultrasound image of failed pregnancies and serum level of hCG pre-evacuation available were included in the study, divided into two groups: complete hydatidiform mole group and non-molar miscarriage group. Serum hCG values were compared, according to gestational age on evacuation day. Statistical analysis used a non-parametric test, 5% significance level (p<0,05), software SPSS 21 (IBM software). Results: The study included 416 patients, 79 patients from non-molar miscarriage group and 337 patients from complete hydatidiform mole group, and the calculated power of the sample was higher than 80%. The data presented shows that the quartile 75th of the non-molar miscarriage group is always lower than the quartile 25th of the complete hydatidiform mole group (9.721mUI/mL/16.435 mUI/mL (6-7 weeks), 20.229 mUI/mL/64.911 mUI/mL (8-9 weeks) and 29.633mUI/mL/126.278 mUI/mL (10-11 weeks), respectively; p<0.001). Conclusion: Facing failed pregnancies, serum hCG level of 16.435 mUI/mL in 6-7 weeks and 64.911 mUI/mL in 8-9 weeks suggest complete hydatidiform mole diagnosis and immediate uterine evacuation should be performed. Bearing in mind that the quartile 75th of the non-molar miscarriage group is 29.633 mUI/mL, it is possible to adopt an expectant conduct if the serum hCG level is below 30.000 mUI/mL, in 10-11 weeks of pregnancy.
Objective: The aim of this study was to associate serum hCG levels as a molar predictor, comparing to non-molar miscarriages, to different gestational ages, below 11 weeks of pregnancy. Secondarily, it was aimed to describe demographic characteristics of women with non evolutive pregnancies and correlate the serum hCG level with histopathological diagnosis of complete hydatidiform mole and nonmolar pregnancy, for each gestation age, below 11 weeks of pregnancy. Methods: This was a retrospective collaborative cohort study conducted at the São Paulo Hospital Trophoblastic Disease Center of São Paulo Federal University and at the Maternity Hospital Trophoblastic Disease Center of Rio de Janeiro Federal University. Patients from 12 to 55 years, assisted from January 1st 2009 to December 31rd 2018, with a gestational age lower than 11 weeks, an ultrasound image of failed pregnancies and serum level of hCG pre-evacuation available were included in the study, divided into two groups: complete hydatidiform mole group and non-molar miscarriage group. Serum hCG values were compared, according to gestational age on evacuation day. Statistical analysis used a non-parametric test, 5% significance level (p<0,05), software SPSS 21 (IBM software). Results: The study included 416 patients, 79 patients from non-molar miscarriage group and 337 patients from complete hydatidiform mole group, and the calculated power of the sample was higher than 80%. The data presented shows that the quartile 75th of the non-molar miscarriage group is always lower than the quartile 25th of the complete hydatidiform mole group (9.721mUI/mL/16.435 mUI/mL (6-7 weeks), 20.229 mUI/mL/64.911 mUI/mL (8-9 weeks) and 29.633mUI/mL/126.278 mUI/mL (10-11 weeks), respectively; p<0.001). Conclusion: Facing failed pregnancies, serum hCG level of 16.435 mUI/mL in 6-7 weeks and 64.911 mUI/mL in 8-9 weeks suggest complete hydatidiform mole diagnosis and immediate uterine evacuation should be performed. Bearing in mind that the quartile 75th of the non-molar miscarriage group is 29.633 mUI/mL, it is possible to adopt an expectant conduct if the serum hCG level is below 30.000 mUI/mL, in 10-11 weeks of pregnancy.