Tuncer Z S, Bernstein M R, Goldstein D P, Berkowitz R S
Gillette Center for Women's Cancers, Harvard Medical School, Boston, Massachusetts 02115, USA.
Gynecol Oncol. 1999 Jun;73(3):345-7. doi: 10.1006/gyno.1999.5437.
To determine the outcome of pregnancies occurring before completion of human chorionic gonadotropin follow-up in patients treated with chemotherapy for gestational trophoblastic tumor.
Retrospective record review of patients with gestational trophoblastic tumor who conceived before standard hCG follow-up was completed during 1973-1998.
Forty-three patients treated for gestational trophoblastic tumors conceived before human chorionic gonadotropin follow-up was completed. The antecedent pregnancy was complete mole in 31 (72.1%) and partial mole in 12 (27. 9%) patients. Of the 43 patients, 39 (90.7%) had stage I, 1 had stage II, and 3 had stage III disease. The mean interval from human chorionic gonadotropin remission to new pregnancy was 6.3 months (range 1-11 months). Ten patients underwent elective termination and four patients were lost to follow-up. Of the remaining 29 patients, 22 (75.9%) had term live births, 3 (10.3%) had preterm delivery, 3 had spontaneous abortion, and 1 (3.5%) had a repeat mole. Two cases of fetal anomalies were detected; one was inherited polydactyly and the other was hydronephrosis. One patient developed choriocarcinoma with lung involvement and underwent cesarean section at 28 weeks; a normal fetus was delivered and no choriocarcinoma was detected in the placenta.
Pregnancies occurring in patients treated for gestational trophoblastic tumor before standard human chorionic gonadotropin follow-up is completed may continue under close clinical surveillance since the majority have a favorable outcome. However, patients should also be advised of the low but important risk of delayed diagnosis in case tumor relapse develops during early subsequent pregnancy.
确定接受化疗的妊娠滋养细胞肿瘤患者在人绒毛膜促性腺激素随访完成前怀孕的结局。
对1973年至1998年期间在标准hCG随访完成前怀孕的妊娠滋养细胞肿瘤患者进行回顾性记录审查。
43例接受妊娠滋养细胞肿瘤治疗的患者在人绒毛膜促性腺激素随访完成前怀孕。先前妊娠为完全性葡萄胎的有31例（72.1%），部分性葡萄胎的有12例（27.9%）。43例患者中，39例（90.7%）为Ⅰ期，1例为Ⅱ期，3例为Ⅲ期疾病。从人绒毛膜促性腺激素缓解到再次怀孕的平均间隔时间为6.3个月（范围1至11个月）。10例患者接受了选择性终止妊娠，4例患者失访。其余29例患者中，22例（75.9%）足月活产，3例（10.3%）早产，3例自然流产，1例（3.5%）再次发生葡萄胎。检测到2例胎儿异常；1例为遗传性多指畸形，另1例为肾积水。1例患者发生肺转移的绒毛膜癌，并在28周时行剖宫产；分娩出正常胎儿，胎盘未检测到绒毛膜癌。
接受妊娠滋养细胞肿瘤治疗的患者在标准人绒毛膜促性腺激素随访完成前怀孕，由于大多数结局良好，可在密切临床监测下继续妊娠。然而，也应告知患者，若后续早期妊娠期间发生肿瘤复发，存在延迟诊断的低但重要的风险。
