Pregnancy after chemotherapy for gestational trophoblastic neoplasia

Abstract

Abstract

Objective: Study of the effect of chemotherapy for gestational trophoblastic neuplasia(GTN) on fertility and the outcome ofsubsequent pregnancy and whether pregnancy plays a role in the relapse of the disease

Materials and methods:patients treated for GTN at Maternity Hospital-damascus university between 2005- 2015 who responded to chemotherapy until  they reached the stage of remission and then continue my review or communicate with me ,we excluded patients who had hesterectomy  as part of or after  treatment  for another reason ,we limited the study to patients aged 35 years or younger (appropriate age for pregnancy).

Results:The number of patients treated during the study period (2005 – 2015 )was 1225 patients,of which 715 were classified in the low risk group and 510 in the high risk group.The first remission rate was 91% in the low risk group (651/715), sixty-four patients resisted treatment and became a high risk group,a remission rate was recorded in the high  risk group 86.2%(495/574),and the overall survival rate was 96.98%(1188/1225).

527 patients were excluded from the study(47 because primary hysterectomy,83 due to secondary hysterectomy after relapse,241 because of lack of communication with them,119 because they are over 35 years of age and lack of desire to conceive and 37 deaths),so the study of subsequent pregnancies(the subject of research) was limited to 698 patients, pregnancy was obtained in 694 patients and failed in four patients for reasons related to the husband.No evidence of lack of fertility was observed after chemotheraby  for GTN.

The number of confirmed pregnancies was 2097, repeat molar pregnancy in 43 cases (2.05%)equivalent to about seven times the common incidence of hydatidiform mole. Abortion occurred in 303 cases(14.46%),the rate of abortion was significantly higher(P=0.0053) among patients who were pregnant within 6 months after the end of treatment than those who waited longer.Pregnancy ended with an early birth in 11 cases and 13 pregnancies ended in stillbirth and the remaining pregnancies (1727)(82.35%) were born at full conception , four cases of congenital abnormality were recorded.Two relapse cases of GTN were recorded after the new pregnancy and they were  repeated moler pregnancy in the form of invasive mole.

Conclusion: There was no lack of fertility after chemotherapy for GTN, and patients who have been treated for GTN can expect  normal future pregnancies,although it is best to avoid pregnancy for 12 months after the end of chemotherapy.

Ther is no fear of pregnancy experience again because there is no increase in the incidence of congenital malformtionand no high chance of relapse, and in order to reduce fear of pregnancy in some patients, psychosocial care must be combined with medical attention.