Uterine arteriovenous malformations (AVMs) are abnormal communications between arteries and veins with resultant high output flow and fibrous intimal thickening of aberrant vessels. Uterine arteriovenous malformations secondary to gestational trophoblastic neoplasia are rare. They commonly present with sudden or persistent vaginal bleeding, often diagnosed through ultrasonography and Doppler studies. Angiography remains to be the gold standard for the diagnosis of uterine AVMs. Definitive treatment is hysterectomy, however for patients who wish to retain their fertility, this should be the last option. This report describes a fertility-sparing surgical management of a uterine arteriovenous malformation in two patients previously treated for gestational trophoblastic neoplasia.

Human ; Female ; Adult ; Arteriovenous Malformations ; Hysterectomy ; Uterine Hemorrhage ; Angiography ; Gestational Trophoblastic Disease ; Arteries ; Ultrasonography

OBJECTIVE: This study aimed to determine the efficacy of methotrexate in preventing postmolar gestational trophoblastic disease (PMGTD) among patients with high-risk complete hydatidiform mole.

METHODS: This was a double-blind randomized controlled trial carried out from 2007 to 2013. A total of 99 patients with high-risk complete hydatidiform mole who underwent suction curettage were randomly allocated to either the treatment or control group. The treatment group received methotrexate while the control group received a vitamin B complex. The number of patients who developed PMGTD in each group was recorded. All tests of significance were carried out at a .05 alpha level of significance, 95% confidence interval.

RESULTS: There was no significant difference between the two groups in terms of age, gravidity, baseline ?hCG, age of gestation, and corpus size. The overall incidence of PMGTD was 27.9%. For the per protocol analysis, a total of 30 patients received chemoprophylaxis while 31 patients received placebo treatment. The total incidence of PMGTD was 16.67% for the treatment group and 38.71% for the control group. The computed risk ratio was 0.43 (95% C.I.: 0.17-1.07, p value = 0.07).

CONCLUSION: Results failed to reach statistical significance but the large fall-out rate may have significantly affected the outcome of the study. Methotrexate chemoprophylaxis may still be useful in preventing PMGTD, particularly in settings where the incidence of hydatidiform mole is high and there is high probability that patients will fail to follow the stringent ?hCG monitoring schedule after molar evacuation.

Human ; Female ; Adult ; Neoplasms