Management of symptomatic uterine arteriovenous malformations after gestational trophoblastic disease: The Brazilian experience and possible role for depot medroxyprogesterone acetate and tranexamic acid treatment

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Autor(es): dc.contributorBrazilian Association of Gestational Trophoblastic Disease-
Autor(es): dc.contributorPerinatal Health of Rio de Janeiro Federal University-
Autor(es): dc.contributorFluminense Federal University-
Autor(es): dc.contributorUniversidade Estadual Paulista (UNESP)-
Autor(es): dc.contributorUniversidade Federal de São Paulo (UNIFESP)-
Autor(es): dc.contributorMario Totta Maternity Ward of Irmandade da Santa Casa de Misericordia Hospital-
Autor(es): dc.contributorUniversidade de São Paulo (USP)-
Autor(es): dc.contributorCaxias do Sul General Hospital of Caxias do Sul University-
Autor(es): dc.contributorNew England Trophoblastic Disease Center-
Autor(es): dc.contributorHarvard Medical School-
Autor(es): dc.creatorBraga, Antonio-
Autor(es): dc.creatorLima, Lana-
Autor(es): dc.creatorParente, Raphael Câmara Medeiros-
Autor(es): dc.creatorCeleste, Roger Keller-
Autor(es): dc.creatorFilho, Jorge De Rezende-
Autor(es): dc.creatorAmim Junior, Joffre-
Autor(es): dc.creatorMaestá, Izildinha-
Autor(es): dc.creatorSun, Sue Yazaki-
Autor(es): dc.creatorUberti, Elza-
Autor(es): dc.creatorLin, Lawrence-
Autor(es): dc.creatorMadi, José Mauro-
Autor(es): dc.creatorViggiano, Maurício-
Autor(es): dc.creatorElias, Kevin M.-
Autor(es): dc.creatorHorowitz, Neil S.-
Autor(es): dc.creatorBerkowitz, Ross S.-
Data de aceite: dc.date.accessioned2025-08-21T22:10:05Z-
Data de disponibilização: dc.date.available2025-08-21T22:10:05Z-
Data de envio: dc.date.issued2022-04-29-
Data de envio: dc.date.issued2022-04-29-
Data de envio: dc.date.issued2018-01-01-
Fonte completa do material: dc.identifierhttp://hdl.handle.net/11449/228548-
Fonte: dc.identifier.urihttp://educapes.capes.gov.br/handle/11449/228548-
Descrição: dc.descriptionOBJECTIVE: To identify predictive variables of heavy vaginal bleeding from uterine arteriovenous malformation (uAVM) after gestational trophoblastic disease (GTD) and review outcomes with different treatment strategies. STUDY DESIGN: This is a retrospective study of patients with uAVM presenting with vaginal bleeding after postmolar follow-up or treatment for postmolar gestational trophoblastic neoplasia, with normal hCG levels for at least 6 or 12 months, respectively, followed at 9 Brazilian GTD reference centers, from January 2004– January 2016. Patients were treated preferentially with uterine artery embolization (UAE), but when UAE wasnot available, depot medroxyprogesterone acetate and tranexamic acid (DMPA+TA) was offered. RESULTS: The incidence of symptomatic uAVM after GTD was 0.6% (39/6,129). Risk factors associated with class III–IV hemorrhage included number of previous curettages (aRR 4.23, 95% CI 1.36–13.1, p=0.013), uterine artery index of resistance ≤0.32 (aRR 35.2, 95% CI 3.58–347.5, p= 0.002), and uterine artery peak systolic velocity ≥78.7 cm/s (aRR 10.7, 95% CI 1.15–100.6, p=0.037). Patients with class I–II hemorrhage treated with DMPA+TA had a higher rate of uAVM resolution (N=14/16 [87.5%]) versus UAE (N=4/8 [50%], p=0.033). Pa-tients with class III–IV hemorrhage were 87% less likely to have successful treatment with DMPA+TA compared to class I–II hemorrhage (cRR 0.13, 95% CI 0.02–0.83, p=0.013). CONCLUSION: Although UAE is preferred for cases of heavy vaginal bleeding, there may be a role for DMPA+TA in the management of less severe bleeding complications.-
Descrição: dc.descriptionRio de Janeiro Trophoblastic Disease Center Brazilian Association of Gestational Trophoblastic Disease-
Descrição: dc.descriptionDepartment of Gynecology and Obstetrics Faculty of Medicine Maternity School Perinatal Health of Rio de Janeiro Federal University-
Descrição: dc.descriptionDepartment of Maternal-Child Faculty of Medicine Antonio Pedro University Hospital Fluminense Federal University-
Descrição: dc.descriptionDepartment of Preventive and Social Dentistry Federal University of Rio Grande do Sul Sao Paulo State University-
Descrição: dc.descriptionBotucatu Trophoblastic Disease Center Department of Gynecology and Obstetrics Botucatu Medical School Sao Paulo State University-
Descrição: dc.descriptionUniversidade Federal de Sao Paulo-
Descrição: dc.descriptionMario Totta Maternity Ward of Irmandade da Santa Casa de Misericordia Hospital-
Descrição: dc.descriptionSao Paulo Clinics Hospital of the University of Sao Paulo-
Descrição: dc.descriptionCaxias do Sul General Hospital of Caxias do Sul University-
Descrição: dc.descriptionClinical Hospital of Goias Federal University Division of Gynecologic Oncology Departments of Obstetrics and Gynecology and of Reproductive Biology New England Trophoblastic Disease Center-
Descrição: dc.descriptionDivision of Gynecologic Oncology Departments of Obstetrics and Gynecology and of Reproductive Biology New England Trophoblastic Disease Center-
Descrição: dc.descriptionBrigham and Women’s Hospital Dana-Farber Cancer Institute Harvard Medical School-
Descrição: dc.descriptionDepartment of Preventive and Social Dentistry Federal University of Rio Grande do Sul Sao Paulo State University-
Descrição: dc.descriptionBotucatu Trophoblastic Disease Center Department of Gynecology and Obstetrics Botucatu Medical School Sao Paulo State University-
Formato: dc.format228-239-
Idioma: dc.languageen-
Relação: dc.relationJournal of Reproductive Medicine-
???dc.source???: dc.sourceScopus-
Palavras-chave: dc.subjectBrazil-
Palavras-chave: dc.subjectDepot medroxyprogesterone acetate-
Palavras-chave: dc.subjectGestational trophoblastic disease-
Palavras-chave: dc.subjectTranexamic acid-
Palavras-chave: dc.subjectUterine arteriovenous malformation-
Palavras-chave: dc.subjectUterine artery embolization-
Título: dc.titleManagement of symptomatic uterine arteriovenous malformations after gestational trophoblastic disease: The Brazilian experience and possible role for depot medroxyprogesterone acetate and tranexamic acid treatment-
Tipo de arquivo: dc.typelivro digital-
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