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Changing Trends in the Clinical Presentation and Management of Complete Hydatidiform Mole Among Brazilian Women
  1. Antonio Braga, MD,
  2. Valéria Moraes, MD,
  3. Izildinha Maestá, MD,
  4. Joffre Amim Júnior, MD,
  5. Jorge de Rezende-Filho, MD,
  6. Kevin Elias, MD and
  7. Ross Berkowitz, MD
  1. * Rio de Janeiro Trophoblastic Disease Center (Maternity School of Rio de Janeiro Federal University, Antonio Pedro University Hospital of Fluminense Federal University, Maternity of Santa Casa da Misericórdia do Rio de Janeiro);
  2. † Professional Master’s Program in Maternal and Child Health, Fluminense Federal University, Niterói;
  3. ‡ Maternity School of Rio de Janeiro Federal University, Professional Master’s Program in Perinatal Health, Rio de Janeiro Federal University, Rio de Janeiro;
  4. § Botucatu Trophoblastic Disease Center, São Paulo State University, Botucatu, Brazil; and
  5. ∥ New England Trophoblastic Disease Center, Donald P. Goldstein MD Trophoblastic Tumor Registry, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Boston, MA.
  1. Address correspondence and reprint requests to Antonio Braga, MD, Gestational Trophoblastic Disease Center of Rio de Janeiro, Maternidade Escola, Universidade Federal do Rio de Janeiro, Rua Laranjeiras, 180, Laranjeiras, Rio de Janeiro, Brazil. E-mail: bragamed{at}yahoo.com.br.

Abstract

Objective The aim of the study was to evaluate potential changes in the clinical, diagnostic, and therapeutic parameters of complete hydatidiform mole in the last 25 years in Brazil.

Methods A retrospective cohort study was conducted involving the analysis of 2163 medical records of patients diagnosed with complete hydatidiform mole who received treatment at the Rio de Janeiro Reference Center for Gestational Trophoblastic Disease between January 1988 and December 2012. For the statistical analysis of the natural history of the patients with complete molar pregnancies, time series were evaluated using the Cox-Stuart test and adjusted by linear regression models.

Results A downward linear temporal trend was observed for gestational age of complete hydatidiform mole at diagnosis, which is also reflected in the reduced occurrence of vaginal bleeding, hyperemesis and pre-eclampsia. We also observed an increase in the use of uterine vacuum aspiration to treat molar pregnancy. Although the duration of postmolar follow-up was found to decline, this was not accompanied by any alteration in the time to remission of the disease or its progression to gestational trophoblastic neoplasia.

Conclusions Early diagnosis of complete hydatidiform mole has altered the natural history of molar pregnancy, especially with a reduction in classical clinical symptoms. However, early diagnosis has not resulted in a reduction in the development of gestational trophoblastic neoplasia, a dilemma that still challenges professionals working with gestational trophoblastic disease.

  • Gestational trophoblastic disease
  • Hydatidiform mole
  • Ultrasound
  • Preeclampsia
  • Hyperthyroidism
  • Uterine hemorrhage

https://doi.org/10.1097/IGC.0000000000000682

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    Footnotes

    • The authors declare no conflicts of interest.