Características clínicas, evolutivas e assistenciais da doença trofoblástica gestacional em dois centros de referência do Ceará
Data
2024-10-29
Autores
Linhares, Eveline Valeriano Moura 
Orientadores
Sun, Sue Yazaki
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivo: Determinar o perfil das mulheres submetidas ao esvaziamento uterino por suspeita de mola hidatiforme (MH), de acordo com suas características sociodemográficas, clínicas, laboratoriais, ultrassonográficas, anatomopatológicas e desfecho em dois serviços de referência no Nordeste do Brasil. Métodos: Estudo de coorte retrospectivo em dois centros de referência entre outubro de 2016 e dezembro de 2022 com mulheres submetidas a esvaziamento uterino por suspeita de MH. Foram avaliadas características sociodemográficas, clínicas, bioquímicas, ultrassonográficas, anatomopatológicas e desfecho. Resultados: 507 mulheres com suspeita clínica de doença trofoblástica gestacional foram admitidas, das quais 334 foram confirmadas, sendo 107 no centro de referência do Hospital Regional Norte- Sobral (CR- HRN): 64 MC, 27 MP, 8 MNC, 4 abortamentos/ restos deciduais, 4 NTG, e 227 no centro de referência da Maternidade Escola Assis Chateaubriand- Fortaleza (CR- MEAC): 136 MC, 78 MP, 5 MNC, 3 abortamentos / restos deciduais, 5 NTG. A distância média entre o centro de referência e a cidade da paciente foi de 88 km. A média de idade das mulheres foi de 27 ± 9 anos, com predomínio de 19 a 39 anos (72%), e aproximadamente 60% dos casos foram diagnosticados ≤ 12 semanas de gestação. Acerca da paridade, a maioria das pacientes eram multíparas 185/55%, sendo que no CR- HRN houve maior percentual (63/58.9%). Sangramento vaginal foi observado em 79.3% das pacientes, e dentre os sintomas associados, prevaleceu pré- eclampsia no CR- MEAC (13/5.7%). Quando comparados os centros, predominou em Fortaleza (p = 0,002), o hCG quantitativo pré- esvaziamento maior que 225 mil. A ultrassonografia transvaginal apresentou aspecto típico em 90% dos exames. O aspecto macroscópico foi descrito como vesícula em 70% dos casos. O esvaziamento uterino foi realizado principalmente por curetagem uterina (44.2%), mas comparando os centros, este procedimento se deu mais por AMIU em Fortaleza (94/41.8%) do que em Sobral (16/15.8%), com significância estatística (p<0.001). A maioria das mulheres não teve complicações (68.6%). O desfecho considerado remissão foi alcançado em 37.1% dos casos; o abandono do seguimento, foi maior em Sobral (26/24.3%) do que em Fortaleza (31/13.7%). Outras 30/9% não chegaram a iniciar o seguimento (15/14% CR- HRN e 15/6.6% no CR- MEAC). Dentre as 73 pacientes acompanhadas por NTG, 9 mulheres abandonaram o seguimento com hCG ainda positivo. Conclusões: Foram analisados os dados de 334 pacientes conduzidas por suspeita de mola nos dois centros, dos quais, 107 casos no CR- HRN e 227 casos no CR- MEAC. A idade média foi 27±9 anos e a idade gestacional média foi 12.6±4.2 semanas, sem diferença entre os centros. Houve maior percentual de multípara (63/58.9%) no CR- HRN. Somente 8/2,4% referiram antecedente obstétrico de DTG. A maioria das mulheres relatou sangramento genital 264/333 (79.3%), e pré- eclampsia foi mais prevalente no CR- MEAC 13/5,7%. A distância percorrida pelas mulheres até os centros de referência foi elevada, mas a maioria delas não apresentou complicações. Categorizando o hCG quantitativo, observou-se que o maior valor (>225mil) foi encontrado na mola completa- 68,4% no CR- HRN e 81,8% no CR- MEAC. A remissão foi observada em 37.1% das mulheres com mola hidatiforme, porém em 48% o desfecho é desconhecido pois tiveram última consulta com hCG ainda positivo. Além disso, 12% das pacientes com NTG também não completaram tratamento. Conclui-se que o seguimento pós-molar e de pacientes em tratamento por NTG nos dois centros estudados, necessitam ser aprimorados pela busca ativa das pacientes, que enfrentam inúmeras barreiras sociais e demográficas.
Objective: To determine the profile of women who underwent uterine evacuation due to suspected hydatidiform mole (HM), based on their sociodemographic, clinical, laboratory, ultrasound, anatomopathological characteristics, and outcome at two referral centers in Northeastern Brazil. Methods: A retrospective cohort study was conducted at two referral centers between October 2016 and December 2022 with women who underwent uterine evacuation due to suspected HM. Sociodemographic, clinical, biochemical, ultrasound, anatomopathological characteristics, and outcomes were evaluated. Results: A total of 507 women with clinical suspicion of gestational trophoblastic disease were admitted, of which 334 were confirmed, with 107 cases at the referral center of the Hospital Regional Norte- Sobral (RC-HRN): ): 64 MC, 27 MP, 8 MNC, 4 miscarriages/ decidual remains, 4 GTN and 227 at the referral center of the Maternidade Escola Assis Chateaubriand- Fortaleza (RC-MEAC): 136 MC, 78 MP, 5 MNC, 3 miscarriages / decidual remains, 5 GTN. The mean distance between the referral center and the patient’s city was 88 km. The mean age of the women was 27 ± 9 years, with a predominance in the 19 to 39-year age group (72%), and approximately 60% of the cases were diagnosed at ≤ 12 weeks of gestation. Evaluating parity, the majority of patients were multiparous 185/55%, and in RC- HRN there was a higher percentage (63/58.9%). Vaginal bleeding was observed in 79.3% of the patients, and among the associated symptoms, pre- eclampsia prevailed in RC- MEAC (13/5.7%). When comparing the centers, pre-evacuation quantitative hCG levels greater than 225,000 were more common in Fortaleza (p=0.002). Transvaginal ultrasound showed typical features in 90% of the exams. The macroscopic appearance was described as vesicular in 70% of the cases. Uterine evacuation was mainly performed via uterine curettage (44.2%), but when comparing the centers, this procedure was more frequently performed by manual vacuum aspiration (MVA) in Fortaleza (94/41.8%) than in Sobral (16/15.8%), with statistical significance (p<0.001). Most women did not experience complications (68.6%). The outcome classified as remission was achieved in 37.1% of cases; the abandonment of follow-up was higher in Sobral (26/24.3%) than in Fortaleza (31/13.7%). Another 30/9% patients did not start follow-up (15/14% RC-HRN and 15/6.6% in RC MEAC). Among the 73 patients followed for gestational trophoblastic neoplasia (GTN), 9 women discontinued follow-up with positive hCG levels. Conclusions: Data from 334 patients treated for suspected moles in the two centers were analyzed, of which 107 cases were in RC- HRN and 227 cases were in RC- MEAC. The average age was 27±9 years and the average gestational age was 12.6±4.2 weeks, no difference between centers. There was a higher percentage of multiparous women (63/58.9% in RC- HRN. Only 8/2.4% reported an obstetric history of GTD. Most women reported genital bleeding 264/ 333 (79.3%), and pre- eclampsia was more prevalent in RC- MEAC 13/5.7%. The distance traveled by women to the referral centers was considerable, but the majority did not experience complications. Categorizing quantitative hCG, it was observed that the highest value (>225,000) was found in complete mole- 68.4% in RC- HRN and 81.8% in RC- MEAC. Remission was observed in 37.1% of the women with hydatidiform mole; however, the outcome for 48% is unknown, as their last visit still showed positive hCG levels. Additionally, 12% of patients with GTN also did not complete treatment. It is concluded that post-molar follow-up and the treatment of GTN patients in both centers studied, need to be improved by the active search for patients, who face numerous social and demographic barriers.
Objective: To determine the profile of women who underwent uterine evacuation due to suspected hydatidiform mole (HM), based on their sociodemographic, clinical, laboratory, ultrasound, anatomopathological characteristics, and outcome at two referral centers in Northeastern Brazil. Methods: A retrospective cohort study was conducted at two referral centers between October 2016 and December 2022 with women who underwent uterine evacuation due to suspected HM. Sociodemographic, clinical, biochemical, ultrasound, anatomopathological characteristics, and outcomes were evaluated. Results: A total of 507 women with clinical suspicion of gestational trophoblastic disease were admitted, of which 334 were confirmed, with 107 cases at the referral center of the Hospital Regional Norte- Sobral (RC-HRN): ): 64 MC, 27 MP, 8 MNC, 4 miscarriages/ decidual remains, 4 GTN and 227 at the referral center of the Maternidade Escola Assis Chateaubriand- Fortaleza (RC-MEAC): 136 MC, 78 MP, 5 MNC, 3 miscarriages / decidual remains, 5 GTN. The mean distance between the referral center and the patient’s city was 88 km. The mean age of the women was 27 ± 9 years, with a predominance in the 19 to 39-year age group (72%), and approximately 60% of the cases were diagnosed at ≤ 12 weeks of gestation. Evaluating parity, the majority of patients were multiparous 185/55%, and in RC- HRN there was a higher percentage (63/58.9%). Vaginal bleeding was observed in 79.3% of the patients, and among the associated symptoms, pre- eclampsia prevailed in RC- MEAC (13/5.7%). When comparing the centers, pre-evacuation quantitative hCG levels greater than 225,000 were more common in Fortaleza (p=0.002). Transvaginal ultrasound showed typical features in 90% of the exams. The macroscopic appearance was described as vesicular in 70% of the cases. Uterine evacuation was mainly performed via uterine curettage (44.2%), but when comparing the centers, this procedure was more frequently performed by manual vacuum aspiration (MVA) in Fortaleza (94/41.8%) than in Sobral (16/15.8%), with statistical significance (p<0.001). Most women did not experience complications (68.6%). The outcome classified as remission was achieved in 37.1% of cases; the abandonment of follow-up was higher in Sobral (26/24.3%) than in Fortaleza (31/13.7%). Another 30/9% patients did not start follow-up (15/14% RC-HRN and 15/6.6% in RC MEAC). Among the 73 patients followed for gestational trophoblastic neoplasia (GTN), 9 women discontinued follow-up with positive hCG levels. Conclusions: Data from 334 patients treated for suspected moles in the two centers were analyzed, of which 107 cases were in RC- HRN and 227 cases were in RC- MEAC. The average age was 27±9 years and the average gestational age was 12.6±4.2 weeks, no difference between centers. There was a higher percentage of multiparous women (63/58.9% in RC- HRN. Only 8/2.4% reported an obstetric history of GTD. Most women reported genital bleeding 264/ 333 (79.3%), and pre- eclampsia was more prevalent in RC- MEAC 13/5.7%. The distance traveled by women to the referral centers was considerable, but the majority did not experience complications. Categorizing quantitative hCG, it was observed that the highest value (>225,000) was found in complete mole- 68.4% in RC- HRN and 81.8% in RC- MEAC. Remission was observed in 37.1% of the women with hydatidiform mole; however, the outcome for 48% is unknown, as their last visit still showed positive hCG levels. Additionally, 12% of patients with GTN also did not complete treatment. It is concluded that post-molar follow-up and the treatment of GTN patients in both centers studied, need to be improved by the active search for patients, who face numerous social and demographic barriers.
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LINHARES, Eveline Valeriano Moura. Características clínicas, evolutivas e assistenciais da doença trofoblástica gestacional em dois centros de referência do Ceará. 2024. 104 f. Tese (Doutorado em Obstetrícia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2024.