levoleucovorin and Uterine-Hemorrhage

Uterine bleeding frequently complicates gestational trophoblastic disease, particularly after uterine evacuation. Hysterectomy and other procedures used to control this bleeding incur significant risk and can limit fertility.. We present a case of massive hemorrhage complicating uterine curettage performed for metastatic gestational trophoblastic disease. The patient's bleeding was controlled successfully by intrauterine tamponade performed using a balloon catheter. After catheter removal, she achieved complete disease remission.. Intrauterine balloon catheterization appears to be a promising alternative to control uterine hemorrhage and preserve fertility for young women undergoing treatment for gestational trophoblastic disease. Its use may help avoid invasive interventions, such as hysterectomy and embolization, currently used to control hemorrhage after uterine evacuation.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Balloon Occlusion; Catheterization; Dactinomycin; Dilatation and Curettage; Etoposide; Female; Gestational Trophoblastic Disease; Humans; Leucovorin; Lung Neoplasms; Methotrexate; Pregnancy; Uterine Hemorrhage

Cervical pregnancy is an uncommon ectopic pregnancy that accounts for approximately <1% of extrauterine gestations. This condition is associated with an extremely high risk of massive hemorrhage and previously often required hysterectomy. Current early ultrasonographic diagnosis and medical management in conjunction with other conservative measures, which include uterine artery embolization and intracervical balloon tamponade, have enabled conservation of the uterus. A young nulliparous patient ultrasonographically diagnosed with a cervical pregnancy and early fetal demise at 11 and 4/7 weeks gestation was managed with high-dose methotrexate and folinic acid rescue treatment. On the second day after treatment was initiated she spontaneously passed an intact gestational sac accompanied by minimal hemorrhage. Treatment was continued, with decreasing serum beta subunit of human chorionic gonadotropin levels and subsiding hemorrhage. Subsequent surgical measures were not required. This case suggests that complete abortion of a cervical pregnancy not necessitating surgical measures can occur.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Female; Fetal Death; Gestational Age; Humans; Leucovorin; Methotrexate; Pregnancy; Pregnancy Trimester, First; Pregnancy, Ectopic; Time Factors; Treatment Outcome; Ultrasonography, Prenatal; Uterine Hemorrhage

Cervical pregnancy is a rare condition that can become life-threatening if heavy bleeding occurs.. Grace (pseudonym) is a 32-year-old woman who was admitted to hospital at approximately 6 weeks' gestational age after several days of heavy bleeding. Ultrasonographic examination revealed the presence of cervical pregnancy. She received multiple doses of methotrexate with folinic acid rescue, and did not require surgical intervention. Nine months after the resolution of the cervical pregnancy, Grace again became pregnant. She had an uncomplicated gestation and a normal vaginal delivery of a healthy baby at term.. Multiple-dose methotrexate with folinic acid rescue was a safe option for the medical treatment of ectopic cervical pregnancy in this case. Long-term toxicity studies and case reports are required to provide more information regarding safety and for clinicians to individualize treatment regimens.

Topics: Abortifacient Agents, Nonsteroidal; Adult; Female; Humans; Leucovorin; Methotrexate; Pregnancy; Pregnancy, Ectopic; Safety; Treatment Outcome; Uterine Hemorrhage

Twin pregnancy consisting of complete hydatidiform mole (H-mole) and a coexisting fetus occurs with an estimated incidence of 1 per 22,000-100,000 pregnancies. The incidence of this unusual twin pregnancy with complete H-mole and a coexisting fetus after in vitro fertilization and embryo transfer (IVF-ET) is not thought to be greater than that of general population. We present an unusual twin pregnancy with complete H-mole and a coexisting fetus that occurred following IVF-ET, which was terminated at 21 weeks of gestation and developed into nonmetastatic gestational trophoblastic tumor.

Topics: Abortion, Therapeutic; Abortion, Threatened; Adult; Antimetabolites, Antineoplastic; Biomarkers, Tumor; Chorionic Gonadotropin, beta Subunit, Human; Combined Modality Therapy; Embryo Transfer; Female; Fertilization in Vitro; Humans; Hydatidiform Mole; Infant, Newborn; Leucovorin; Male; Methotrexate; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy, Multiple; Uterine Hemorrhage; Uterine Neoplasms

Cervical pregnancy has traditionally been treated by hysterectomy. Recent reports of the use of methotrexate have been encouraging as a potential conservative approach. We present a case of a cervical pregnancy diagnosed at 8 weeks' gestation in a woman who greatly desired fertility. She was treated successfully with a combination of multidose intramuscular methotrexate (1 mg/kg/day) and citrovorum rescue. When profuse bleeding developed on day 8, angiographic embolization was used to obviate surgery. The beta-hCG titer peaked at 58,362 IU/mL and was undetectable by postchemotherapy day 30. No blood transfusion was required, and reproductive capacity was spared. Four months after the cervical pregnancy, the patient became pregnant and had a healthy infant. Medical management of cervical pregnancy is an option when reproductive capacity is desired in selected patients with appropriate counseling.

Topics: Adult; Antidotes; Arteries; Embolization, Therapeutic; Female; Folic Acid Antagonists; Gestational Age; Humans; Injections, Intramuscular; Leucovorin; Methotrexate; Pregnancy; Pregnancy, Ectopic; Uterine Hemorrhage; Uterus

The purpose of this article is to evaluate the effectiveness, side effects, and complications of high dose methotrexate infusion with leucovorin rescue in select patients with ectopic pregnancy. Between January 1991 and November 1994, 28 patients with ectopic pregnancies were prospectively treated with methotrexate (100 mg/m2 intravenous bolus followed by a 200 mg/m2 infusion over six hours) with leucovorin rescue. Twenty-seven of 28 patients (96%) were successfully treated. Only one patient (4%) required a second course of methotrexate to reach a normal hCG titer. One patient failed methotrexate infusion 45 days after treatment at a hCG titer of 12 mIU/mL. No Gynecologic Oncology Group grade 3 or 4 clinical, biochemical or hematologic toxicities occurred. Uterine bleeding and abdominal pain, not requiring transfusion or hospitalization, occurred in 71% and 56% of patients. The authors conclude that high dose methotrexate infusion with leucovorin rescue is a highly effective, well tolerated, nonsurgical treatment for select patients with ectopic pregnancy.

Topics: Abdominal Pain; Administration, Oral; Adult; Ambulatory Care; Antidotes; Chorionic Gonadotropin; Female; Folic Acid Antagonists; Follow-Up Studies; Hospitalization; Humans; Infusions, Intravenous; Injections, Intravenous; Leucovorin; Methotrexate; Pregnancy; Pregnancy, Ectopic; Prospective Studies; Treatment Outcome; Ultrasonography; Uterine Hemorrhage

Five patients with gestational trophoblastic disease whose presenting symptom was hemorrhage from vaginal metastases have been added to our previous report. The clinical features, management, and responses to treatment are outlined. All the patients required suturing of the bleeding lesions under general anesthetic to arrest the hemorrhage. In addition one patient needed selective arterial embolization. This did not compromise the response to chemotherapy. We confirm our previous view that the presence of vaginal metastases should be classified as a high-risk factor and that these patients be treated with multiple agent chemotherapy from the outset.

Topics: Adult; Age Factors; Antineoplastic Combined Chemotherapy Protocols; Curettage; Cyclophosphamide; Dactinomycin; Embolization, Therapeutic; Female; Hemostasis, Surgical; Humans; Leucovorin; Methotrexate; Middle Aged; Parity; Pregnancy; Trophoblastic Neoplasms; Uterine Hemorrhage; Uterine Neoplasms; Vaginal Neoplasms