Severe uterine haemorrhagic complications from gestational trophoblastic neoplasia

Objective

Gestational trophoblastic neoplasia are highly vascularized infiltrating lesions that can lead to severe haemorrhagic complications. The aim of this study was to describe the characteristics of patients with gestational trophoblastic neoplasia who experienced uterine haemorrhagic complications, and their management.

Study design

This retrospective study analysed the histories of 2099 patients with gestational trophoblastic neoplasia registered at the French Reference Centre for Trophoblastic Disease between 1999 and 2023.

Results

Among 2099 patients with a confirmed diagnosis of gestational trophoblastic neoplasia, 38 patients who experienced uterine haemorrhagic complications requiring interventional treatment were identified. Among them, 23 (61%) had a low-risk tumour and 15 (39%) had a high-risk tumour according to their International Federation of Gynecology and Obstetrics score. Twenty (53%) patients experienced haemoperitoneum and 18 (47%) patients experienced massive vaginal bleeding. Seventeen (45%) patients experienced uterine rupture. Haemorrhagic treatment consisted of surgery for 26 (70%) patients, exclusive uterine embolization for six (16%) patients, embolization followed by surgery for four (11%) patients, and embolization after failure to control bleeding by aspiration for one (3%) patient. Of the five deaths (13%), one (3%) was related to the uterine haemorrhagic complication. Three of 15 (20%) patients treated conservatively reported subsequent pregnancies.

Conclusion

There are no established guidelines for managing severe uterine haemorrhagic complications. The availability of interventional radiology resources could allow for increased use of fertility-preserving procedures, with encouraging results regarding subsequent pregnancies.