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Gravidez molar

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  • Теория
  • Диагноз
  • Лечение
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Последний просмотренный: 13 Dec 2025
Last updated: 18 Jan 2024

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • presença de fatores de risco
  • primeiro trimestre da gestação
  • sangramento vaginal
  • tamanho uterino incomum para a idade gestacional
Полная информация

Другие диагностические факторы

  • pré-eclâmpsia de início precoce
  • dispneia e desconforto respiratório
  • náuseas e vômitos intensos
  • taquicardia, tremor, insônia e diarreia
  • palidez
  • dor pélvica
  • sangramento uterino
Полная информация

Факторы риска

  • extremidades etárias maternas
  • gravidez molar prévia
  • gordura e caroteno reduzidos na dieta
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • exame histológico do tecido placentário
  • gonadotrofina coriônica humana (hCG) sérica
  • ultrassonografia pélvica
Полная информация

Исследования, проведение которых нужно рассмотреть

  • Hemograma completo
  • tempo de protrombina (TP), tempo de tromboplastina parcial (TTP) séricos
  • perfil metabólico sérico
  • hormônio estimulante da tireoide (TSH) sérico
  • tipagem sanguínea com rastreamento de anticorpos
  • radiografia torácica
Полная информация

Алгоритм лечения

Острый

gravidez molar única: pacientes que desejam manter a fertilidade

gravidez molar única: pacientes que não desejam manter a fertilidade

feto gêmeo viável: interrupção eletiva não desejada

feto gêmeo viável: interrupção eletiva

ПРОДОЛЖЕНИЕ

após o manejo inicial: alto risco de neoplasia trofoblástica gestacional com conclusão do acompanhamento improvável

Составители

Авторы

Antonio Braga, MD

Associate Professor

Department of Obstetrics and Gynecology

Rio de Janeiro Federal University

Department of Maternal Child

Fluminense Federal University

Rio de Janeiro

Brazil

Раскрытие информации

AB is an author of references cited in this topic.

Kevin M. Elias, MD

Assistant Professor

Brigham and Women’s Hospital

Dana Farber Cancer Institute

New England Trophoblastic Disease Center

Division of Gynecologic Oncology

Department of Obstetrics, Gynecology and Reproductive Biology

Harvard Medical School

Boston

MA

Раскрытие информации

KME has been a paid consultant for AOA Dx and received research support from Aspira Women’s Health and Abcam, Inc. KME is an author of references cited in this topic.

Neil S. Horowitz, MD

Associate Professor

Brigham and Women’s Hospital

Dana Farber Cancer Institute

New England Trophoblastic Disease Center

Division of Gynecologic Oncology

Department of Obstetrics, Gynecology and Reproductive Biology

Harvard Medical School

Boston

MA

Раскрытие информации

NSH is an author of references cited in this topic.

Ross S. Berkowitz, MD

William H. Baker Professor of Gynecology

Brigham and Women’s Hospital

Dana Farber Cancer Institute

New England Trophoblastic Disease Center

Division of Gynecologic Oncology

Department of Obstetrics, Gynecology and Reproductive Biology

Harvard Medical School

Boston

MA

Раскрытие информации

RSB is an author of references cited in this topic.

Выражение благодарностей

Dr Ross S. Berkowitz, Dr Kevin M. Elias, Dr Neil S. Horowitz, and Dr Antonio Braga would like to gratefully acknowledge Dr John Soper and Dr Emma Rossi, previous contributors to this topic. JS and ER declare that they have no competing interests.

Рецензенты

Jane Stewart, PhD, MSc

Consultant Gynecologist

Subspecialist in Reproductive Medicine

Newcastle Fertility Centre at Life

Bioscience Centre

International Centre at Life

Newcastle upon Tyne

UK

Раскрытие информации

JS declares that she has no competing interests.

Philip Savage, PhD, FRCP

Consultant in Medical Oncology

Department of Medical Oncology

Charing Cross Hospital

London

UK

Раскрытие информации

PS declares that he has no competing interests.

Aparna Sundaram, DO, MBA, MPH

Physician Consultant

Preventive Medicine

Private Practice

Atlanta

GA

Раскрытие информации

AS declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Horowitz NS, Eskander RN, Adelman MR, et al. Epidemiology, diagnosis, and treatment of gestational trophoblastic disease: A Society of Gynecologic Oncology evidenced-based review and recommendation. Gynecol Oncol. 2021 Dec;163(3):605-13.Полный текст  Аннотация

Ngan HYS, Seckl MJ, Berkowitz RS, et al. Diagnosis and management of gestational trophoblastic disease: 2021 update. Int J Gynaecol Obstet. 2021 Oct;155 Suppl 1(suppl 1):86-93.Полный текст  Аннотация

Tidy, J, Seckl, M, Hancock, BW, on behalf of the Royal College of Obstetricians and Gynaecologists. Management of gestational trophoblastic disease. BJOG 2021;128: e1-e27​.Полный текст

Lok C, van Trommel N, Massuger L, et al. Practical clinical guidelines of the EOTTD for treatment and referral of gestational trophoblastic disease. Eur J Cancer. 2020 May;130:228-40. Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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