title: Management of massive hemorrhage in patients with gestational trophoblastic neoplasia by angiographic embolization: a safer alternative.
abstract: OBJECTIVE
  To assess the usefulness of angiographic embolization in hemorrhage due to gestational trophoblastic neoplasia (GTN).
  
  
  METHODS
  We conducted a retrospective analysis of data of patients with gestational trophoblastic disease within the time period 2002-2008.
  
  
  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.
  
  
  CONCLUSIONS
  Transcatheter embolization is a safe and quick procedure and should be considered in GTN patients with acute hemorrhagic life-threatening complications.
authors.affiliation: Departments of Obstetrics and Gynecology and of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Anish
authors.initials: A
authors.lastname: Keepanasseril
authors.forename: Vanita
authors.initials: V
authors.lastname: Suri
authors.forename: G R V
authors.initials: GR
authors.lastname: Prasad
authors.forename: Vivek
authors.initials: V
authors.lastname: Gupta
authors.forename: Rashmi
authors.initials: R
authors.lastname: Bagga
authors.forename: Neelam
authors.initials: N
authors.lastname: Aggarwal
authors.forename: Lakhbir Kaur
authors.initials: LK
authors.lastname: Dhaliwal
authors.forename: Niranjan
authors.initials: N
authors.lastname: Khandelwal
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D004621:Embolization, Therapeutic; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000098:blood supply / Q000150:complications* / Q000188:drug therapy; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D011247:Pregnancy; D015641:Radiography, Interventional; D012189:Retrospective Studies; D055988:Uterine Artery / Q000000981:diagnostic imaging; D014592:Uterine Hemorrhage / Q000209:etiology / Q000628:therapy*; D014594:Uterine Neoplasms / Q000098:blood supply / Q000150:complications* / Q000188:drug therapy
chemical_list: D000970:Antineoplastic Agents