title: Ten-Year Experience with the Conservative Management of Abnormally Invasive, Residual Trophoblastic Disease. A Retrospective Case Series.
abstract: Conservative management of abnormally invasive, residual trophoblastic disease (AIRTD) is underreported. We aimed at critically reviewing our experience with such conservative management. We conducted a retrospective cohort study that included 24 women. The median completed week of gestation at delivery (20/24, 83.3%)/2nd trimester miscarriage (4/24, 16.7%) was 35 (range 17-41). Two women initially chose a surgical treatment (dilatation and curettage), but AIRTD remained sonographically visible afterward. Five patients developed a fever >38.0°C for ≥2 days (5/24, 20.8%). Due to heavy vaginal bleeding, 2 patients then underwent dilatation, diagnostic hysteroscopy, and curettage (2/24, 8.3%). One of these women also had to undergo hysterectomy (1/24, 4.2%). The 23 patients without hysterectomy underwent regular sonographic follow-up examinations. Regression of AIRTD was found after a median of 74 days (range 36-323). In conclusion, our data suggest that a conservative, observational treatment is feasible in AIRTD, with low rates of secondary surgical interventions. The long time intervals until regression require perseverance by these patients.
authors.affiliation: Department of Obstetrics and Gynecology, Krankenhaus Hietzing, Vienna, Austria.
authors.forename: Regina
authors.initials: R
authors.lastname: Promberger
authors.forename: Johannes
authors.initials: J
authors.lastname: Ott
authors.forename: Kinga M
authors.initials: KM
authors.lastname: Chalubinski
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D000072700:Conservative Treatment; D003475:Curettage; D004107:Dilatation and Curettage; D005260:Female; D005865:Gestational Age; D031901:Gestational Trophoblastic Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy; D011247:Pregnancy; D012189:Retrospective Studies; D014463:Ultrasonography; D014592:Uterine Hemorrhage