title: Pregnancy after EMA/CO for gestational trophoblastic disease: a report from The Netherlands.
abstract: OBJECTIVE
  To investigate whether a desire for pregnancy changed after etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA/CO) treatment for gestational trophoblastic disease and whether the incidence of infertility and adverse pregnancy outcome differed from the general population.
  
  
  METHODS
  A cohort study was performed. Data were collected from hospital records and questionnaires.
  
  
  METHODS
  The study was carried out in referral hospitals in The Netherlands.
  
  
  METHODS
  All women registered by the Dutch Working Party on Trophoblastic Disease and treated with EMA/CO were included.
  
  
  METHODS
  A questionnaire was sent to all surviving patients treated with EMA/CO from 1986 until 1997. Women who underwent a hysterectomy were excluded from the study.
  
  
  METHODS
  Pregnancy outcome and pregnancy wish after chemotherapy.
  
  
  RESULTS
  Fifty patients were treated with EMA/CO. In 86%, a complete remission was achieved. A questionnaire was sent to 33 patients. Response rate was 82% (27/33). After EMA/CO, 18 of the patients experienced a regular menstrual cycle. Three patients had an amenorrhoea. Fourteen patients had a pregnancy wish. Twelve patients conceived; 21 pregnancies occurred. Sixteen pregnancies were term deliveries. Two pregnancies ended in a miscarriage and two congenitally abnormal children were delivered prematurely.
  
  
  CONCLUSIONS
  After EMA/CO, 86% of women with a pregnancy wish achieved pregnancy. However, women can be so anxious about a new pregnancy that they refrain from it. A causative relation between the two congenitally abnormal children and EMA/CO cannot be determined because of the small sample. The rate of miscarriages is not higher than in the general population. We can reassure patients that pregnancy after EMA/CO has a high probability of success and a favourable outcome. To diminish the fear of getting pregnant in some patients, psychosocial care should be considered in addition to medical care.
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: C A R
authors.initials: CA
authors.lastname: Lok
authors.forename: C
authors.initials: C
authors.lastname: van der Houwen
authors.forename: M J
authors.initials: MJ
authors.lastname: ten Kate-Booij
authors.forename: M A
authors.initials: MA
authors.lastname: van Eijkeren
authors.forename: A C
authors.initials: AC
authors.lastname: Ansink
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D001007:Anxiety / Q000209:etiology; D001294:Attitude to Health; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006828:Hydatidiform Mole / Q000188:drug therapy / Q000523:psychology*; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009042:Motivation; D009426:Netherlands; D011247:Pregnancy / Q000523:psychology*; D011256:Pregnancy Outcome; D011379:Prognosis; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000523:psychology*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate