The Experts below are selected from a list of 2118 Experts worldwide ranked by ideXlab platform
Ross S. Berkowitz - One of the best experts on this subject based on the ideXlab platform.
-
impact of clinical characteristics on human chorionic gonadotropin regression after Molar Pregnancy
Clinics, 2021Co-Authors: A A Gockley, Ross S. Berkowitz, Donald P. Goldstein, Kevin M Elias, Sue Yazaki Sun, Alexander Melamed, Lawrence Hsu Lin, Michelle Davis, Anthony Rizzo, Neil S HorowitzAbstract:OBJECTIVES: This study aimed to determine the effects of age, race/ethnicity, body mass index, and contraception on human chorionic gonadotropin (hCG) regression following the evacuation of a Molar Pregnancy. METHODS: This was a retrospective cohort study of 277 patients with Molar pregnancies between January 1, 1994 and December 31, 2015. The rate of hCG regression was estimated using mixed-effects linear regression models on daily log-transformed serum hCG levels after evacuation. RESULTS: There were no differences in hCG half-lives among age (p=0.13) or race/ethnicity (p=0.16) groups. Women with obesity and hormonal contraceptive use demonstrated faster hCG regression than their counterparts (3.2 versus. 3.7 days, p=0.02 and 3.4 versus. 4.0 days, p=0.002, respectively). CONCLUSION: Age and race/ethnicity were not associated with hCG regression rates. Hormonal contraceptive use and obesity were associated with shorter hCG half-lives, but with unlikely clinical significance. It is important to understand whether the clinical characteristics of patients may influence the hCG regression curve, as it has been proposed as a way to predict the risk of gestational trophoblastic neoplasia.
-
manual compared with electric vacuum aspiration for treatment of Molar Pregnancy
Obstetrics & Gynecology, 2018Co-Authors: Lilian Padron, Neil S Horowitz, Antonio Braga, Izildinha Maesta, Joffre Amim, Kevin M Elias, Sue Yazaki Sun, Jorge Rezende Filho, Rafael Cortes Charry, Ross S. BerkowitzAbstract:OBJECTIVE:To evaluate uterine evacuation of patients with Molar Pregnancy, comparing manual with electric vacuum aspiration.METHODS:This is a retrospective cohort study of patients with Molar Pregnancy followed at the Rio de Janeiro Trophoblastic Disease Center from January 2007 to December 2016. Th
-
effect of race ethnicity on clinical presentation and risk of gestational trophoblastic neoplasia in patients with complete and partial Molar Pregnancy at a tertiary care referral center
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Donald P. Goldstein, Marilyn R Bernstein, Alexander Melamed, A A Gockley, Naima T Joseph, Benjamin Goodwin, Ross S. BerkowitzAbstract:Background The reported incidence of Molar Pregnancy varies widely among different geographic locations. This variation has been attributed, at least in part, to racial/ethnic differences. While the incidence of Molar pregnancies is decreasing, certain ethnic groups such as Hispanics, Asians, and American Indians continue to have an increased risk of developing gestational trophoblastic disease across the globe. Objective We sought to describe the potential effect of ethnicity/race on the presentation and clinical course of complete mole and partial mole. Study Design All patients followed up for complete mole and partial mole at a single institution referral center from 1994 through 2013 were identified. Variables including age, race, gravidity, parity, gestational age, presenting signs/symptoms, serum human chorionic gonadotropin values, and development of gestational trophoblastic neoplasia were extracted from medical records and patient surveys. Patients with complete mole and partial mole were categorized into race/ethnicity groups defined as white, black, Asian, or Hispanic. Due to low numbers of non-white patients with partial mole in each non-white category, patients with partial mole were grouped as white or non-white. Continuous variables were compared using the Kruskal-Wallis test and binary variables were compared using the Fisher exact test. Results A total of 167 complete mole patients with known race/ethnicity status were included (57.48% white, 14.97% Asian, 14.37% black, 13.17% Hispanic). Hispanics presented at younger age (median 24.5 years) compared to whites (median 32.0 years, P = .04) and Asians (median 31.0 years, P = .03). Blacks had higher gravidity than whites ( P P = .05). There was no significant difference in presenting symptoms, gestational age at diagnosis, and preevacuation serum human chorionic gonadotropin level by race/ethnicity. Hispanics were significantly less likely than whites to develop gestational trophoblastic neoplasia (absolute risk difference, 28.6%; 95% confidence interval, 8.1–39.2%; P = .02). A total of 144 patients with partial mole were analyzed. There were 108 white and 36 non-white patients. Median age was 31 years for white and 29 years for non-white patients ( P = .006). Median gravidity was 2 for white and 3 for non-white patients ( P P = .003). There were no significant differences with respect to presenting signs and symptoms, gestational age, preevacuation human chorionic gonadotropin level, or risk of progression to gestational trophoblastic neoplasia. Conclusion Hispanic patients with complete Molar Pregnancy had a significantly lower risk of developing gestational trophoblastic neoplasia than white patients. There were no significant differences among groups in terms of presenting symptoms, gestational age at diagnosis, or preevacuation human chorionic gonadotropin levels for either complete mole or partial mole patients.
-
changing trends in the clinical presentation and management of complete hydatidiform mole among brazilian women
International Journal of Gynecological Cancer, 2016Co-Authors: Antonio Braga, Valeria Moraes, Izildinha Maesta, Joffre Amim, Jorge Rezendefilho, Kevin M Elias, Ross S. BerkowitzAbstract:Objective The aim of the study was to evaluate potential changes in the clinical, diagnostic, and therapeutic parameters of complete hydatidiform mole in the last 25 years in Brazil. Methods A retrospective cohort study was conducted involving the analysis of 2163 medical records of patients diagnosed with complete hydatidiform mole who received treatment at the Rio de Janeiro Reference Center for Gestational Trophoblastic Disease between January 1988 and December 2012. For the statistical analysis of the natural history of the patients with complete Molar pregnancies, time series were evaluated using the Cox-Stuart test and adjusted by linear regression models. Results A downward linear temporal trend was observed for gestational age of complete hydatidiform mole at diagnosis, which is also reflected in the reduced occurrence of vaginal bleeding, hyperemesis and pre-eclampsia. We also observed an increase in the use of uterine vacuum aspiration to treat Molar Pregnancy. Although the duration of postMolar follow-up was found to decline, this was not accompanied by any alteration in the time to remission of the disease or its progression to gestational trophoblastic neoplasia. Conclusions Early diagnosis of complete hydatidiform mole has altered the natural history of Molar Pregnancy, especially with a reduction in classical clinical symptoms. However, early diagnosis has not resulted in a reduction in the development of gestational trophoblastic neoplasia, a dilemma that still challenges professionals working with gestational trophoblastic disease.
-
timing of referral to the new england trophoblastic disease center does referral with Molar Pregnancy versus postMolar gestational trophoblastic neoplasia affect outcomes
Gynecologic Oncology, 2016Co-Authors: E J Diver, Ross S. Berkowitz, Donald P. Goldstein, Neil S Horowitz, Marilyn R Bernstein, Whitfield B GrowdonAbstract:Objective To assess if referral of patients with Molar Pregnancy who then developed postMolar gestational trophoblastic neoplasia (PMGTN) is associated with different outcomes when compared to referral of patients already with a diagnosis of PMGTN. Study design The records of the New England Trophoblastic Disease Center (NETDC) were queried for all patients with Molar Pregnancy or PMGTN from 1993-2013. Retrospective chart review was performed to extract relevant clinical and demographic data. Parametric and nonparametric tests were utilized to compare variables. Results From 1993-2013, 429 women with Molar disease were evaluated at the NETDC. Of those, 68% were referred with Molar Pregnancy and 32% were referred with PMGTN. Comparing women with PMGTN who were referred with a Molar Pregnancy versus referred with PMGTN, the women were of equivalent stage and World Health Organization (WHO) score. Additionally, referral with Molar Pregnancy or PMGTN did not associate with time to persistence, time to remission, or number of lines of chemotherapy administered. Conclusion In this trophoblastic disease specialty center in the United States, referral at the time of PMGTN as opposed to at diagnosis of Molar Pregnancy did not appear to affect the stage or WHO score at diagnosis, the need for multiple chemotherapy lines, or time to remission.
Donald P. Goldstein - One of the best experts on this subject based on the ideXlab platform.
-
impact of clinical characteristics on human chorionic gonadotropin regression after Molar Pregnancy
Clinics, 2021Co-Authors: A A Gockley, Ross S. Berkowitz, Donald P. Goldstein, Kevin M Elias, Sue Yazaki Sun, Alexander Melamed, Lawrence Hsu Lin, Michelle Davis, Anthony Rizzo, Neil S HorowitzAbstract:OBJECTIVES: This study aimed to determine the effects of age, race/ethnicity, body mass index, and contraception on human chorionic gonadotropin (hCG) regression following the evacuation of a Molar Pregnancy. METHODS: This was a retrospective cohort study of 277 patients with Molar pregnancies between January 1, 1994 and December 31, 2015. The rate of hCG regression was estimated using mixed-effects linear regression models on daily log-transformed serum hCG levels after evacuation. RESULTS: There were no differences in hCG half-lives among age (p=0.13) or race/ethnicity (p=0.16) groups. Women with obesity and hormonal contraceptive use demonstrated faster hCG regression than their counterparts (3.2 versus. 3.7 days, p=0.02 and 3.4 versus. 4.0 days, p=0.002, respectively). CONCLUSION: Age and race/ethnicity were not associated with hCG regression rates. Hormonal contraceptive use and obesity were associated with shorter hCG half-lives, but with unlikely clinical significance. It is important to understand whether the clinical characteristics of patients may influence the hCG regression curve, as it has been proposed as a way to predict the risk of gestational trophoblastic neoplasia.
-
effect of race ethnicity on risk of complete and partial Molar Pregnancy after adjustment for age
Gynecologic Oncology, 2016Co-Authors: Sue Yazaki Sun, Alexander Melamed, A A Gockley, Naima T Joseph, Mark A Clapp, Donald P. GoldsteinAbstract:Abstract Objective To quantify the effect of race/ethnicity on risk of complete and partial Molar Pregnancy. Methods We conducted a cross-sectional study including women who were followed for complete or partial mole and those who had a live singleton birth in a teaching hospital in the northeastern United States between 2000 and 2013. We calculated race/ethnicity-specific risk of complete and partial mole per 10,000 live births, and used logistic regression to estimate crude and age-adjusted relative risks (RR) of complete and partial mole. Results We identified 140 cases of complete mole, 115 cases of partial mole, and 105,942 live births. The risk of complete mole was 13 cases per 10,000 live births (95% confidence interval [CI] 11–16) and that of partial mole was 11 cases per 10,000 live births (95% CI 9–13). After age-adjustment, Asians were more likely to develop complete mole (RR 2.3 95% CI 1.4–3.8, p p =0.002) and partial mole (RR 0.4; 95% CI 0.2–0.9, p=0.02). Conclusion Race/ethnicity is a significant risk factor for both complete and partial Molar Pregnancy in the northeastern United States.
-
effect of race ethnicity on clinical presentation and risk of gestational trophoblastic neoplasia in patients with complete and partial Molar Pregnancy at a tertiary care referral center
American Journal of Obstetrics and Gynecology, 2016Co-Authors: Donald P. Goldstein, Marilyn R Bernstein, Alexander Melamed, A A Gockley, Naima T Joseph, Benjamin Goodwin, Ross S. BerkowitzAbstract:Background The reported incidence of Molar Pregnancy varies widely among different geographic locations. This variation has been attributed, at least in part, to racial/ethnic differences. While the incidence of Molar pregnancies is decreasing, certain ethnic groups such as Hispanics, Asians, and American Indians continue to have an increased risk of developing gestational trophoblastic disease across the globe. Objective We sought to describe the potential effect of ethnicity/race on the presentation and clinical course of complete mole and partial mole. Study Design All patients followed up for complete mole and partial mole at a single institution referral center from 1994 through 2013 were identified. Variables including age, race, gravidity, parity, gestational age, presenting signs/symptoms, serum human chorionic gonadotropin values, and development of gestational trophoblastic neoplasia were extracted from medical records and patient surveys. Patients with complete mole and partial mole were categorized into race/ethnicity groups defined as white, black, Asian, or Hispanic. Due to low numbers of non-white patients with partial mole in each non-white category, patients with partial mole were grouped as white or non-white. Continuous variables were compared using the Kruskal-Wallis test and binary variables were compared using the Fisher exact test. Results A total of 167 complete mole patients with known race/ethnicity status were included (57.48% white, 14.97% Asian, 14.37% black, 13.17% Hispanic). Hispanics presented at younger age (median 24.5 years) compared to whites (median 32.0 years, P = .04) and Asians (median 31.0 years, P = .03). Blacks had higher gravidity than whites ( P P = .05). There was no significant difference in presenting symptoms, gestational age at diagnosis, and preevacuation serum human chorionic gonadotropin level by race/ethnicity. Hispanics were significantly less likely than whites to develop gestational trophoblastic neoplasia (absolute risk difference, 28.6%; 95% confidence interval, 8.1–39.2%; P = .02). A total of 144 patients with partial mole were analyzed. There were 108 white and 36 non-white patients. Median age was 31 years for white and 29 years for non-white patients ( P = .006). Median gravidity was 2 for white and 3 for non-white patients ( P P = .003). There were no significant differences with respect to presenting signs and symptoms, gestational age, preevacuation human chorionic gonadotropin level, or risk of progression to gestational trophoblastic neoplasia. Conclusion Hispanic patients with complete Molar Pregnancy had a significantly lower risk of developing gestational trophoblastic neoplasia than white patients. There were no significant differences among groups in terms of presenting symptoms, gestational age at diagnosis, or preevacuation human chorionic gonadotropin levels for either complete mole or partial mole patients.
-
timing of referral to the new england trophoblastic disease center does referral with Molar Pregnancy versus postMolar gestational trophoblastic neoplasia affect outcomes
Gynecologic Oncology, 2016Co-Authors: E J Diver, Ross S. Berkowitz, Donald P. Goldstein, Neil S Horowitz, Marilyn R Bernstein, Whitfield B GrowdonAbstract:Objective To assess if referral of patients with Molar Pregnancy who then developed postMolar gestational trophoblastic neoplasia (PMGTN) is associated with different outcomes when compared to referral of patients already with a diagnosis of PMGTN. Study design The records of the New England Trophoblastic Disease Center (NETDC) were queried for all patients with Molar Pregnancy or PMGTN from 1993-2013. Retrospective chart review was performed to extract relevant clinical and demographic data. Parametric and nonparametric tests were utilized to compare variables. Results From 1993-2013, 429 women with Molar disease were evaluated at the NETDC. Of those, 68% were referred with Molar Pregnancy and 32% were referred with PMGTN. Comparing women with PMGTN who were referred with a Molar Pregnancy versus referred with PMGTN, the women were of equivalent stage and World Health Organization (WHO) score. Additionally, referral with Molar Pregnancy or PMGTN did not associate with time to persistence, time to remission, or number of lines of chemotherapy administered. Conclusion In this trophoblastic disease specialty center in the United States, referral at the time of PMGTN as opposed to at diagnosis of Molar Pregnancy did not appear to affect the stage or WHO score at diagnosis, the need for multiple chemotherapy lines, or time to remission.
-
maternal near miss according to world health organization classification among women with a hydatidiform mole experience at the new england trophoblastic disease center 1994 2013
Journal of Reproductive Medicine, 2016Co-Authors: Sue Yazaki Sun, Donald P. Goldstein, Neil S Horowitz, Antonio Braga, Izildinha Maesta, M R Bernstein, Rosiane Mattar, Ross S. BerkowitzAbstract:Objective To investigate the frequency of potentially life-threatening conditions (PLTCs) and maternal near misses (MNMs) at the New England Trophoblastic Disease Center (NETDC) in recent years, when there has been earlier diagnosis of Molar Pregnancy. Study design This study included patients with Molar Pregnancy at the NETDC between 1994 and 2013. Clinical and pathologic reports were reviewed. PLTC and MNM criteria and maternal deaths were searched in medical records using the World Health Organization criteria and classification. Results We identified 375 patients with Molar Pregnancy and no patient developed a MNM or maternal death. Only 6 (1.6%) had PLTCs (hemorrhage with hemodynamic instability, severe preeclampsia, respiratory distress, blood transfusion, and ICU admission). Conclusion We observed a low rate of PLTC and no cases of MNMs or maternal deaths related to Molar Pregnancy, likely due to earlier diagnosis at the NETDC in recent years.
Neil S Horowitz - One of the best experts on this subject based on the ideXlab platform.
-
impact of clinical characteristics on human chorionic gonadotropin regression after Molar Pregnancy
Clinics, 2021Co-Authors: A A Gockley, Ross S. Berkowitz, Donald P. Goldstein, Kevin M Elias, Sue Yazaki Sun, Alexander Melamed, Lawrence Hsu Lin, Michelle Davis, Anthony Rizzo, Neil S HorowitzAbstract:OBJECTIVES: This study aimed to determine the effects of age, race/ethnicity, body mass index, and contraception on human chorionic gonadotropin (hCG) regression following the evacuation of a Molar Pregnancy. METHODS: This was a retrospective cohort study of 277 patients with Molar pregnancies between January 1, 1994 and December 31, 2015. The rate of hCG regression was estimated using mixed-effects linear regression models on daily log-transformed serum hCG levels after evacuation. RESULTS: There were no differences in hCG half-lives among age (p=0.13) or race/ethnicity (p=0.16) groups. Women with obesity and hormonal contraceptive use demonstrated faster hCG regression than their counterparts (3.2 versus. 3.7 days, p=0.02 and 3.4 versus. 4.0 days, p=0.002, respectively). CONCLUSION: Age and race/ethnicity were not associated with hCG regression rates. Hormonal contraceptive use and obesity were associated with shorter hCG half-lives, but with unlikely clinical significance. It is important to understand whether the clinical characteristics of patients may influence the hCG regression curve, as it has been proposed as a way to predict the risk of gestational trophoblastic neoplasia.
-
manual compared with electric vacuum aspiration for treatment of Molar Pregnancy
Obstetrics & Gynecology, 2018Co-Authors: Lilian Padron, Neil S Horowitz, Antonio Braga, Izildinha Maesta, Joffre Amim, Kevin M Elias, Sue Yazaki Sun, Jorge Rezende Filho, Rafael Cortes Charry, Ross S. BerkowitzAbstract:OBJECTIVE:To evaluate uterine evacuation of patients with Molar Pregnancy, comparing manual with electric vacuum aspiration.METHODS:This is a retrospective cohort study of patients with Molar Pregnancy followed at the Rio de Janeiro Trophoblastic Disease Center from January 2007 to December 2016. Th
-
timing of referral to the new england trophoblastic disease center does referral with Molar Pregnancy versus postMolar gestational trophoblastic neoplasia affect outcomes
Gynecologic Oncology, 2016Co-Authors: E J Diver, Ross S. Berkowitz, Donald P. Goldstein, Neil S Horowitz, Marilyn R Bernstein, Whitfield B GrowdonAbstract:Objective To assess if referral of patients with Molar Pregnancy who then developed postMolar gestational trophoblastic neoplasia (PMGTN) is associated with different outcomes when compared to referral of patients already with a diagnosis of PMGTN. Study design The records of the New England Trophoblastic Disease Center (NETDC) were queried for all patients with Molar Pregnancy or PMGTN from 1993-2013. Retrospective chart review was performed to extract relevant clinical and demographic data. Parametric and nonparametric tests were utilized to compare variables. Results From 1993-2013, 429 women with Molar disease were evaluated at the NETDC. Of those, 68% were referred with Molar Pregnancy and 32% were referred with PMGTN. Comparing women with PMGTN who were referred with a Molar Pregnancy versus referred with PMGTN, the women were of equivalent stage and World Health Organization (WHO) score. Additionally, referral with Molar Pregnancy or PMGTN did not associate with time to persistence, time to remission, or number of lines of chemotherapy administered. Conclusion In this trophoblastic disease specialty center in the United States, referral at the time of PMGTN as opposed to at diagnosis of Molar Pregnancy did not appear to affect the stage or WHO score at diagnosis, the need for multiple chemotherapy lines, or time to remission.
-
maternal near miss according to world health organization classification among women with a hydatidiform mole experience at the new england trophoblastic disease center 1994 2013
Journal of Reproductive Medicine, 2016Co-Authors: Sue Yazaki Sun, Donald P. Goldstein, Neil S Horowitz, Antonio Braga, Izildinha Maesta, M R Bernstein, Rosiane Mattar, Ross S. BerkowitzAbstract:Objective To investigate the frequency of potentially life-threatening conditions (PLTCs) and maternal near misses (MNMs) at the New England Trophoblastic Disease Center (NETDC) in recent years, when there has been earlier diagnosis of Molar Pregnancy. Study design This study included patients with Molar Pregnancy at the NETDC between 1994 and 2013. Clinical and pathologic reports were reviewed. PLTC and MNM criteria and maternal deaths were searched in medical records using the World Health Organization criteria and classification. Results We identified 375 patients with Molar Pregnancy and no patient developed a MNM or maternal death. Only 6 (1.6%) had PLTCs (hemorrhage with hemodynamic instability, severe preeclampsia, respiratory distress, blood transfusion, and ICU admission). Conclusion We observed a low rate of PLTC and no cases of MNMs or maternal deaths related to Molar Pregnancy, likely due to earlier diagnosis at the NETDC in recent years.
-
first trimester ultrasound in gestational trophoblastic disease
2016Co-Authors: Katharine M Esselen, Donald P. Goldstein, Neil S Horowitz, Ross S. BerkowitzAbstract:Ultrasound plays an important role in the diagnosis and management of patients with gestational trophoblastic disease (GTD), including Molar Pregnancy and gestational trophoblastic neoplasia (GTN). The initial diagnosis of complete hydatidiform mole (CHM) is generally made with a markedly elevated human chorionic gonadotropin (hCG) and an abnormal ultrasound which exhibits the classic snowstorm or grape-like appearance of the hydropic villi. The initial diagnosis of partial hydatidiform mole (PHM) by ultrasound in early Pregnancy is less reliable. Overall, ultrasound is 34–57 % sensitive in diagnosing Molar Pregnancy in the first trimester. The use of transvaginal ultrasound and color Doppler enhances the ability to assess the presence and extent of intrauterine disease in patients with GTN. Ultrasound measurement of uterine artery pulsations is predictive of the need for chemotherapy and may provide an indication of chemosensitivity in the management of patients. Furthermore, ultrasound is useful for the long-term follow-up of patients with GTD who develop abnormal bleeding following treatment to identify persistent disease or arteriovenous malformations. Lastly, ultrasound is essential in evaluating subsequent pregnancies to exclude recurrent GTD.
Antonio Braga - One of the best experts on this subject based on the ideXlab platform.
-
manual compared with electric vacuum aspiration for treatment of Molar Pregnancy
Obstetrics & Gynecology, 2018Co-Authors: Lilian Padron, Neil S Horowitz, Antonio Braga, Izildinha Maesta, Joffre Amim, Kevin M Elias, Sue Yazaki Sun, Jorge Rezende Filho, Rafael Cortes Charry, Ross S. BerkowitzAbstract:OBJECTIVE:To evaluate uterine evacuation of patients with Molar Pregnancy, comparing manual with electric vacuum aspiration.METHODS:This is a retrospective cohort study of patients with Molar Pregnancy followed at the Rio de Janeiro Trophoblastic Disease Center from January 2007 to December 2016. Th
-
Gestational Trophoblastic Neoplasia after Ectopic Molar Pregnancy: Clinical, Diagnostic, and Therapeutic Aspects
2018Co-Authors: Consuelo Lozoya López, Sue Yazaki Sun, Lilian Padron, Vania Gloria Silami Lopes, Fabiana Rodrigues Resende, Jessica Lara Steim, Edward Araujo Júnior, Antonio BragaAbstract:Abstract This report presents the case of a patient with gestational trophoblastic neoplasia after a partial hydatidiform mole formed in the Fallopian tube. Ectopic Molar Pregnancy is a rare condition, with an estimated incidence of 1 in every 20,000 to 100,000 pregnancies; less than 300 cases of it have been reported in the Western literature. The present report is important because it presents current diagnostic criteria for this rare condition, which has been incorrectly diagnosed in the past, not only morphologically but also immunohistochemically. It also draws the attention of obstetricians to the occurrence of ectopic Molar Pregnancy, which tends to progress to Fallopian tube rupture more often than in cases of ectopic non-Molar Pregnancy. Progression to gestational trophoblastic neoplasia ensures that patients with ectopic Molar Pregnancy must undergo postMolar monitoring, which must be just as thorough as that of patients with intrauterine hydatidiform moles, even if chemotherapy results in high cure rates.
-
a twin Pregnancy with a hydatidiform mole and a coexisting live fetus prenatal diagnosis treatment and follow up
Journal of Ultrasonography, 2017Co-Authors: Antonio Braga, Joffre Amim, Bruna Obeica, Heron Werner, Sue Yazaki Sun, Jorge Rezende Filho, Edward AraujoAbstract:Twin Molar Pregnancy with a hydatidiform mole and a coexisting live fetus is a rare form of gestational trophoblastic disease associated with an increased risk of obstetric complications and poor perinatal outcome. Prenatal diagnosis is essential for couple counseling and follow-up in Tertiary Reference Centers. Magnetic resonance imaging is important for the diagnostic differentiation of placental mesenchymal dysplasia and exclusion of myometrial invasion. Here we present a case of twin Molar Pregnancy with a hydatidiform mole and a coexisting live fetus diagnosed at gestational week 14 using two-dimensional (2D) and three-dimensional (3D) ultrasound and magnetic resonance imaging. We also describe the obstetric management and postMolar follow-up.
-
changing trends in the clinical presentation and management of complete hydatidiform mole among brazilian women
International Journal of Gynecological Cancer, 2016Co-Authors: Antonio Braga, Valeria Moraes, Izildinha Maesta, Joffre Amim, Jorge Rezendefilho, Kevin M Elias, Ross S. BerkowitzAbstract:Objective The aim of the study was to evaluate potential changes in the clinical, diagnostic, and therapeutic parameters of complete hydatidiform mole in the last 25 years in Brazil. Methods A retrospective cohort study was conducted involving the analysis of 2163 medical records of patients diagnosed with complete hydatidiform mole who received treatment at the Rio de Janeiro Reference Center for Gestational Trophoblastic Disease between January 1988 and December 2012. For the statistical analysis of the natural history of the patients with complete Molar pregnancies, time series were evaluated using the Cox-Stuart test and adjusted by linear regression models. Results A downward linear temporal trend was observed for gestational age of complete hydatidiform mole at diagnosis, which is also reflected in the reduced occurrence of vaginal bleeding, hyperemesis and pre-eclampsia. We also observed an increase in the use of uterine vacuum aspiration to treat Molar Pregnancy. Although the duration of postMolar follow-up was found to decline, this was not accompanied by any alteration in the time to remission of the disease or its progression to gestational trophoblastic neoplasia. Conclusions Early diagnosis of complete hydatidiform mole has altered the natural history of Molar Pregnancy, especially with a reduction in classical clinical symptoms. However, early diagnosis has not resulted in a reduction in the development of gestational trophoblastic neoplasia, a dilemma that still challenges professionals working with gestational trophoblastic disease.
-
maternal near miss according to world health organization classification among women with a hydatidiform mole experience at the new england trophoblastic disease center 1994 2013
Journal of Reproductive Medicine, 2016Co-Authors: Sue Yazaki Sun, Donald P. Goldstein, Neil S Horowitz, Antonio Braga, Izildinha Maesta, M R Bernstein, Rosiane Mattar, Ross S. BerkowitzAbstract:Objective To investigate the frequency of potentially life-threatening conditions (PLTCs) and maternal near misses (MNMs) at the New England Trophoblastic Disease Center (NETDC) in recent years, when there has been earlier diagnosis of Molar Pregnancy. Study design This study included patients with Molar Pregnancy at the NETDC between 1994 and 2013. Clinical and pathologic reports were reviewed. PLTC and MNM criteria and maternal deaths were searched in medical records using the World Health Organization criteria and classification. Results We identified 375 patients with Molar Pregnancy and no patient developed a MNM or maternal death. Only 6 (1.6%) had PLTCs (hemorrhage with hemodynamic instability, severe preeclampsia, respiratory distress, blood transfusion, and ICU admission). Conclusion We observed a low rate of PLTC and no cases of MNMs or maternal deaths related to Molar Pregnancy, likely due to earlier diagnosis at the NETDC in recent years.
Sue Yazaki Sun - One of the best experts on this subject based on the ideXlab platform.
-
impact of clinical characteristics on human chorionic gonadotropin regression after Molar Pregnancy
Clinics, 2021Co-Authors: A A Gockley, Ross S. Berkowitz, Donald P. Goldstein, Kevin M Elias, Sue Yazaki Sun, Alexander Melamed, Lawrence Hsu Lin, Michelle Davis, Anthony Rizzo, Neil S HorowitzAbstract:OBJECTIVES: This study aimed to determine the effects of age, race/ethnicity, body mass index, and contraception on human chorionic gonadotropin (hCG) regression following the evacuation of a Molar Pregnancy. METHODS: This was a retrospective cohort study of 277 patients with Molar pregnancies between January 1, 1994 and December 31, 2015. The rate of hCG regression was estimated using mixed-effects linear regression models on daily log-transformed serum hCG levels after evacuation. RESULTS: There were no differences in hCG half-lives among age (p=0.13) or race/ethnicity (p=0.16) groups. Women with obesity and hormonal contraceptive use demonstrated faster hCG regression than their counterparts (3.2 versus. 3.7 days, p=0.02 and 3.4 versus. 4.0 days, p=0.002, respectively). CONCLUSION: Age and race/ethnicity were not associated with hCG regression rates. Hormonal contraceptive use and obesity were associated with shorter hCG half-lives, but with unlikely clinical significance. It is important to understand whether the clinical characteristics of patients may influence the hCG regression curve, as it has been proposed as a way to predict the risk of gestational trophoblastic neoplasia.
-
manual compared with electric vacuum aspiration for treatment of Molar Pregnancy
Obstetrics & Gynecology, 2018Co-Authors: Lilian Padron, Neil S Horowitz, Antonio Braga, Izildinha Maesta, Joffre Amim, Kevin M Elias, Sue Yazaki Sun, Jorge Rezende Filho, Rafael Cortes Charry, Ross S. BerkowitzAbstract:OBJECTIVE:To evaluate uterine evacuation of patients with Molar Pregnancy, comparing manual with electric vacuum aspiration.METHODS:This is a retrospective cohort study of patients with Molar Pregnancy followed at the Rio de Janeiro Trophoblastic Disease Center from January 2007 to December 2016. Th
-
Gestational Trophoblastic Neoplasia after Ectopic Molar Pregnancy: Clinical, Diagnostic, and Therapeutic Aspects
2018Co-Authors: Consuelo Lozoya López, Sue Yazaki Sun, Lilian Padron, Vania Gloria Silami Lopes, Fabiana Rodrigues Resende, Jessica Lara Steim, Edward Araujo Júnior, Antonio BragaAbstract:Abstract This report presents the case of a patient with gestational trophoblastic neoplasia after a partial hydatidiform mole formed in the Fallopian tube. Ectopic Molar Pregnancy is a rare condition, with an estimated incidence of 1 in every 20,000 to 100,000 pregnancies; less than 300 cases of it have been reported in the Western literature. The present report is important because it presents current diagnostic criteria for this rare condition, which has been incorrectly diagnosed in the past, not only morphologically but also immunohistochemically. It also draws the attention of obstetricians to the occurrence of ectopic Molar Pregnancy, which tends to progress to Fallopian tube rupture more often than in cases of ectopic non-Molar Pregnancy. Progression to gestational trophoblastic neoplasia ensures that patients with ectopic Molar Pregnancy must undergo postMolar monitoring, which must be just as thorough as that of patients with intrauterine hydatidiform moles, even if chemotherapy results in high cure rates.
-
a twin Pregnancy with a hydatidiform mole and a coexisting live fetus prenatal diagnosis treatment and follow up
Journal of Ultrasonography, 2017Co-Authors: Antonio Braga, Joffre Amim, Bruna Obeica, Heron Werner, Sue Yazaki Sun, Jorge Rezende Filho, Edward AraujoAbstract:Twin Molar Pregnancy with a hydatidiform mole and a coexisting live fetus is a rare form of gestational trophoblastic disease associated with an increased risk of obstetric complications and poor perinatal outcome. Prenatal diagnosis is essential for couple counseling and follow-up in Tertiary Reference Centers. Magnetic resonance imaging is important for the diagnostic differentiation of placental mesenchymal dysplasia and exclusion of myometrial invasion. Here we present a case of twin Molar Pregnancy with a hydatidiform mole and a coexisting live fetus diagnosed at gestational week 14 using two-dimensional (2D) and three-dimensional (3D) ultrasound and magnetic resonance imaging. We also describe the obstetric management and postMolar follow-up.
-
effect of race ethnicity on risk of complete and partial Molar Pregnancy after adjustment for age
Gynecologic Oncology, 2016Co-Authors: Sue Yazaki Sun, Alexander Melamed, A A Gockley, Naima T Joseph, Mark A Clapp, Donald P. GoldsteinAbstract:Abstract Objective To quantify the effect of race/ethnicity on risk of complete and partial Molar Pregnancy. Methods We conducted a cross-sectional study including women who were followed for complete or partial mole and those who had a live singleton birth in a teaching hospital in the northeastern United States between 2000 and 2013. We calculated race/ethnicity-specific risk of complete and partial mole per 10,000 live births, and used logistic regression to estimate crude and age-adjusted relative risks (RR) of complete and partial mole. Results We identified 140 cases of complete mole, 115 cases of partial mole, and 105,942 live births. The risk of complete mole was 13 cases per 10,000 live births (95% confidence interval [CI] 11–16) and that of partial mole was 11 cases per 10,000 live births (95% CI 9–13). After age-adjustment, Asians were more likely to develop complete mole (RR 2.3 95% CI 1.4–3.8, p p =0.002) and partial mole (RR 0.4; 95% CI 0.2–0.9, p=0.02). Conclusion Race/ethnicity is a significant risk factor for both complete and partial Molar Pregnancy in the northeastern United States.