title: Reproductive outcome after discharge of patients with high-risk hydatidiform mole with or without use of one bolus dose of actinomycin D, as prophylactic chemotherapy, during the uterine evacuation of molar pregnancy.
abstract: OBJECTIVE
  To evaluate whether prophylactic chemotherapy (P-chem) with one bolus dose of actinomycin D (Act-D) during the uterine evacuation of patients with high-risk hydatidiform mole (Hr-HM) affects reproductive outcomes in subsequent pregnancies.
  
  
  METHODS
  From 1987 to 2006, 1090 patients with gestational trophoblastic disease (GTD) were evaluated at a Trophoblastic Disease Center in southern Brazil; 265 with Hr-HM were selected and retrospectively analyzed. From 1996 to 2006, 163 received one bolus dose of Act-D at the time of uterine evacuation (Hr-HM-chem group); 102 with the same risk factors did not get P-chem (Hr-HM-control group). In March 2009, the number of pregnancies, progression of first pregnancy, and association of low age and low parity with subsequent pregnancy were evaluated.
  
  
  RESULTS
  The percentage of patients that became pregnant was similar in both groups (Hr-HM-control: 59.5%; Hr-HM-chem group: 45.7%; p=0.069) and independent of HM progression. Percentages of no pregnancies because of age (> or =40 years) or hysterectomy were also similar. Type of subsequent pregnancy was not statistically different between groups, and the rate of live births associated with pregnancies for which US showed a live fetus was high. Frequency of repeat GTD was unexpectedly high in both groups (4.2% and 6.3%; p=1.00).
  
  
  CONCLUSIONS
  P-chem did not affect reproductive outcomes for patients with Hr-HM. Patients allowed to become pregnant again in both groups had high rates of live births associated with normal pregnancies. Chances of a subsequent pregnancy were higher in the low age and low parity subgroups.
authors.affiliation: TDC of CHSCPA, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil. elzauberti@terra.com.br
authors.forename: Elza Maria Hartmann
authors.initials: EM
authors.lastname: Uberti
authors.forename: Maria do Carmo
authors.initials: Mdo C
authors.lastname: Fajardo
authors.forename: Silvia Villa Verde Ribeiro
authors.initials: SV
authors.lastname: Ferreira
authors.forename: Maurício Vannoni
authors.initials: MV
authors.lastname: Pereira
authors.forename: Raquel Cristina
authors.initials: RC
authors.lastname: Seger
authors.forename: Maria Amélia Rolla
authors.initials: MA
authors.lastname: Moreira
authors.forename: Magali Duarte
authors.initials: MD
authors.lastname: Torres
authors.forename: Gilberto
authors.initials: G
authors.lastname: de Nápoli
authors.forename: Helena
authors.initials: H
authors.lastname: Schmid
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006828:Hydatidiform Mole / Q000188:drug therapy* / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012098:Reproduction; D055815:Young Adult
chemical_list: D003609:Dactinomycin