Obstetric outcomes after medroxyprogesterone acetate treatment for early stage endometrial cancer or atypical endometrial hyperplasia: a single hospital-based study.
Female
Humans
Pregnancy
Dilatation and Curettage
Endometrial Hyperplasia
/ drug therapy
Endometrial Neoplasms
/ drug therapy
Hospitals
Medroxyprogesterone Acetate
/ adverse effects
Neoplasm Staging
Placenta Accreta
/ chemically induced
Premature Birth
Retrospective Studies
Obstetrics
Adult
Middle Aged
Atypical endometrial hyperplasia
Endometrial cancer
Medroxyprogesterone acetate
Placenta accreta
Pregnancy
Journal
International journal of clinical oncology
ISSN: 1437-7772
Titre abrégé: Int J Clin Oncol
Pays: Japan
ID NLM: 9616295
Informations de publication
Date de publication:
Apr 2023
Apr 2023
Historique:
received:
14
11
2022
accepted:
11
01
2023
medline:
4
4
2023
pubmed:
21
1
2023
entrez:
20
1
2023
Statut:
ppublish
Résumé
To investigate perinatal outcomes in pregnancy after high-dose medroxyprogesterone acetate (MPA) therapy for early stage endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) and to determine whether pregnancy after MPA therapy is at a higher risk of placenta accreta. Data of 51 pregnancies in 46 women who received MPA therapy for EC or AEH and delivered after 22 weeks of gestation at Keio University Hospital were reviewed. A retrospective matched case-control study was performed to determine the risk of placenta accreta in pregnancy after MPA therapy compared with singleton pregnancies without any history of maternal malignancy treatments. The incidence of placenta accreta was higher in the MPA group than in the control group (15.7 vs. 0%, p = 0.0058). However, no differences in other perinatal outcomes were observed between groups. While gestational weeks at delivery in the MPA group were later than those in the control group (p = 0.0058), no difference in the incidence of preterm delivery was recorded between groups. In the MPA therapy group, the number of patients who underwent ≥ 6 dilation and curettage (D&C) was higher in the placenta accreta group than in the non-placenta accreta group (50.0 vs. 14.0%, p = 0.018). Patients with ≥ 6 D&Cs demonstrated a 6.0-fold increased risk of placenta accreta (p = 0.043, 95% CI 1.05-34.1) than those receiving ≤ 3 D&Cs. Pregnancy after MPA therapy is associated with a high risk of placenta accreta. In cases in which the frequency of D&C is high, placenta accreta should be considered.
Sections du résumé
BACKGROUND
BACKGROUND
To investigate perinatal outcomes in pregnancy after high-dose medroxyprogesterone acetate (MPA) therapy for early stage endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) and to determine whether pregnancy after MPA therapy is at a higher risk of placenta accreta.
METHODS
METHODS
Data of 51 pregnancies in 46 women who received MPA therapy for EC or AEH and delivered after 22 weeks of gestation at Keio University Hospital were reviewed. A retrospective matched case-control study was performed to determine the risk of placenta accreta in pregnancy after MPA therapy compared with singleton pregnancies without any history of maternal malignancy treatments.
RESULTS
RESULTS
The incidence of placenta accreta was higher in the MPA group than in the control group (15.7 vs. 0%, p = 0.0058). However, no differences in other perinatal outcomes were observed between groups. While gestational weeks at delivery in the MPA group were later than those in the control group (p = 0.0058), no difference in the incidence of preterm delivery was recorded between groups. In the MPA therapy group, the number of patients who underwent ≥ 6 dilation and curettage (D&C) was higher in the placenta accreta group than in the non-placenta accreta group (50.0 vs. 14.0%, p = 0.018). Patients with ≥ 6 D&Cs demonstrated a 6.0-fold increased risk of placenta accreta (p = 0.043, 95% CI 1.05-34.1) than those receiving ≤ 3 D&Cs.
CONCLUSION
CONCLUSIONS
Pregnancy after MPA therapy is associated with a high risk of placenta accreta. In cases in which the frequency of D&C is high, placenta accreta should be considered.
Identifiants
pubmed: 36662363
doi: 10.1007/s10147-023-02297-y
pii: 10.1007/s10147-023-02297-y
doi:
Substances chimiques
Medroxyprogesterone Acetate
C2QI4IOI2G
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
587-591Subventions
Organisme : JSPS KAKENHI
ID : 20K18173
Informations de copyright
© 2023. The Author(s) under exclusive licence to Japan Society of Clinical Oncology.
Références
Yamagami W, Aoki D (2015) Annual report of the committee on gynecologic oncology, the japan society of obstetrics and gynecology. J Obstet Gynaecol Res 41:1861–1869
doi: 10.1111/jog.12833
pubmed: 26420746
Gallos ID, Yap J, Rajkhowa M et al (2012) Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol 207:266.e1-266.12
doi: 10.1016/j.ajog.2012.08.011
pubmed: 23021687
Yamagami W, Susumu N, Makabe T et al (2018) Is repeated high-dose medroxyprogesterone acetate (MPA) therapy permissible for patients with early stage endometrial cancer or atypical endometrial hyperplasia who desire preserving fertility? J Gynecol Oncol 29:e21
doi: 10.3802/jgo.2018.29.e21
pubmed: 29400014
pmcid: 5823982
Inoue O, Hamatani T, Susumu N et al (2016) Factors affecting pregnancy outcomes in young women treated with fertility-preserving therapy for well-differentiated endometrial cancer or atypical endometrial hyperplasia. Reprod Biol Endocrinol 14:2
doi: 10.1186/s12958-015-0136-7
pubmed: 26769300
pmcid: 4714532
Ota Y, Watanabe H, Fukasawa I et al (1999) Placenta accreta/increta. Review of 10 cases and a case report. Arch Gynecol Obstet 263:69–72
doi: 10.1007/s004040050265
pubmed: 10728633
Greenbaum S, Wainstock T, Dukler D et al (2017) Underlying mechanisms of retained placenta: evidence from a population based cohort study. Eur J Obstet Gynecol Reprod Biol 216:12–17
doi: 10.1016/j.ejogrb.2017.06.035
pubmed: 28692888
Baldwin HJ, Patterson JA, Nippita TA et al (2018) Antecedents of abnormally invasive placenta in primiparous women: risk associated with gynecologic procedures. Obstet Gynecol 131:227–233
doi: 10.1097/AOG.0000000000002434
pubmed: 29324602
Beuker JM, Erwich JJ, Khong TY (2005) Is endomyometrial injury during termination of pregnancy or curettage following miscarriage the precursor to placenta accreta? J Clin Pathol 58:273–275
doi: 10.1136/jcp.2004.020602
pubmed: 15735159
pmcid: 1770603
Tamauchi S, Kajiyama H, Utsumi F et al (2018) Efficacy of medroxyprogesterone acetate treatment and retreatment for atypical endometrial hyperplasia and endometrial cancer. J Obstet Gynaecol Res 44:151–156
doi: 10.1111/jog.13473
pubmed: 29121428
Vaugon M, Peigné M, Phelippeau J et al (2021) IVF impact on the risk of recurrence of endometrial adenocarcinoma after fertility-sparing management. Reprod Biomed Online 43:495–502
doi: 10.1016/j.rbmo.2021.06.007
pubmed: 34315696
Park JY, Seong SJ, Kim TJ et al (2013) Pregnancy outcomes after fertility-sparing management in young women with early endometrial cancer. Obstet Gynecol 121:136–142
doi: 10.1097/AOG.0b013e31827a0643
pubmed: 23262938
Arendas K, Aldossary M, Cipolla A et al (2015) Hysteroscopic resection in the management of early-stage endometrial cancer: report of 2 cases and review of the literature. J Minim Invasive Gynecol 22:34–39
doi: 10.1016/j.jmig.2014.08.782
pubmed: 25196160
Yang HC, Liu JC, Liu FS (2019) Fertility-preserving treatment of stage IA, well-differentiated endometrial carcinoma in young women with hysteroscopic resection and high-dose progesterone therapy. Taiwan J Obstet Gynecol 58:90–93
doi: 10.1016/j.tjog.2018.11.017
pubmed: 30638488
Polyzos NP, Mauri D, Tsioras S et al (2010) Intraperitoneal dissemination of endometrial cancer cell after hysteroscopy. Int J Gynecol Cancer 20:261–267
doi: 10.1111/IGC.0b013e3181ca2290
pubmed: 20169669
Cicinelli E, Tinelli R, Colafiglio G et al (2010) Risk of long-term pelvic recurrences after fluid minihysteroscopy in women with endometrial carcinoma. Menopause 17:511–515
doi: 10.1097/gme.0b013e3181c8534d
pubmed: 20081548