September 1st, 2014

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Title:
Management of Massive Hemorrhage in Patients with Gestational Trophoblastic Neoplasia by Angiographic Embolization: A Safer Alternative
Authors:  A. Keepanasseril, M.D., V. Suri, M.D., G. R. V. Prasad, M.D., V. Gupta, M.D., R. Bagga, M.D., N. Aggarwal, M.D., L. K. Dhaliwal, M.D., and N. Khandelwal, M.D.
  OBJECTIVE: To assess the usefulness of angiographic embolization in hemorrhage due to gestational trophoblastic neoplasia (GTN).

STUDY DESIGN: We conducted a retrospective analysis of data of patients with gestational trophoblastic disease within the time period 20022008.

RESULTS: Eight women with GTN presented with massive hemorrhage during this time period. According to the International Federation of Gynecology and Obstetrics Scoring system 2000, 4 of those patients had high-risk GTN. Vaginal metastasis was present in 50% of the women. All women underwent angiography, and embolization was performed in 7 of the 8 patients. One patient could not undergo embolization due to technical reasons. Two patients underwent embolization of bilateral internal iliac arteries, 4 had bilateral uterine artery embolization and 1 had bilateral uterine and hepatic artery embolization. Embolization was successful in 85.7% of the patients. All patients received chemotherapy: high-risk patients received combined regimen chemotherapy (EMA-CO), while low-risk cases received methotrexate/folinic acid regimen. Out of the 8 patients, 5 are in remission and 3 succumbed to the disease. In 2 women who tried to conceive, 1 delivered a term infant and the other had a miscarriage. The most common side effect of embolization was pain requiring parenteral analgesia.

CONCLUSION: Transcatheter embolization is a safe and quick procedure and should be considered in GTN patients with acute hemorrhagic life-threatening complications.
Keywords:  choriocarcinoma, gestational trophoblastic neoplasms, hemorrhage, uterine artery embolization
   
   
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