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Pregnancy after EMA/CO for gestational trophoblastic disease: a report from The Netherlands
C A R Lok1, C van der Houwen, M J ten Kate-Booij
1Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands.
Objective:
To investigate whether a desire for pregnancy changed after etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (EMA/CO) treatment for gestational trophoblastic disease and whether the incidence of infertility and adverse pregnancy outcome differed from the general population.
Design:
A cohort study was performed. Data were collected from hospital records and questionnaires.
Setting:
The study was carried out in referral hospitals in The Netherlands.
Population:
All women registered by the Dutch Working Party on Trophoblastic Disease and treated with EMA/CO were included.
Methods:
A questionnaire was sent to all surviving patients treated with EMA/CO from 1986 until 1997. Women who underwent a hysterectomy were excluded from the study.
Main Outcome Measure:
Pregnancy outcome and pregnancy wish after chemotherapy.
Results:
Fifty patients were treated with EMA/CO. In 86%, a complete remission was achieved. A questionnaire was sent to 33 patients. Response rate was 82% (27/33). After EMA/CO, 18 of the patients experienced a regular menstrual cycle. Three patients had an amenorrhoea. Fourteen patients had a pregnancy wish. Twelve patients conceived; 21 pregnancies occurred. Sixteen pregnancies were term deliveries. Two pregnancies ended in a miscarriage and two congenitally abnormal children were delivered prematurely.
Conclusion:
After EMA/CO, 86% of women with a pregnancy wish achieved pregnancy. However, women can be so anxious about a new pregnancy that they refrain from it. A causative relation between the two congenitally abnormal children and EMA/CO cannot be determined because of the small sample. The rate of miscarriages is not higher than in the general population. We can reassure patients that pregnancy after EMA/CO has a high probability of success and a favourable outcome. To diminish the fear of getting pregnant in some patients, psychosocial care should be considered in addition to medical care.