Demet AYDOĞAN KIRMIZI, Emre BAŞER, Taylan ONAT, Melike DEMİR ÇALTEKİN, Ethem Serdar YALVAÇ

Mol evakuasyonu sonrası trofoblastik pulmoner emboli: Olgu sunumu

Pulmoner trofoblast hücre embolizasyonu normal/anormal gebeliklerde oluşabilen ve klinik belirtileri genellikle ilk 72 saat içinde destek tedavileri ile düzelen bir durumdur. Sunulan olgu, fazla trofoblastik yükün bir göstergesi olabilecek yüksek β-hCG değerleri ve büyük uterin cesameti olan, evakuasyon tedavisi sonrası 8. saatinde non-trombotik pulmoner trofoblast hücre embolisi gelişen ve multidisipliner yönetilerek destek tedavisi ile 4. günden sonra şikayetleri gerileyen literatürde az örneği olan, nadir bir olgudur.

Anahtar Kelimeler:

Molar gebelik, trofoblast, pulmoner emboli

TROPHOBLASTIC PULMONARY EMBOLIZATION AFTER MOLAR EVACUATION

Pulmonary trophoblast cell embolization is a condition that can occur in normal/abnormal pregnancies. Clinical symptoms usually improve with supportive treatment within 72 hours. Here, we present a case who had high β-hCG values indicative of excessive trophoblastic burden, and who had a big uterus. The patient developed non-thrombotic pulmonary trophoblast cell embolism at 8th hour after the evacuation treatment. This is a rare case whose complaints regressed after the fourth day of supportive therapy with multidisciplinary management.

Keywords:

Molar pregnancy, Trophoblast, Pulmonary Embolization,

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1. Gadducci A, Lanfredini N, Cosio S. Reproductive outcomes after hydatiform mole and gestational trophoblastic neoplasia. Gynecol Endocrinol 2015; 31:673-678.
2. Delmis J, Pfeifer D, Ivanisevic M, Forko JI, Hlupic L. Sudden death from trophoblastic embolism in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2000; 92:225-227.
3. Douglas GW, Thomas L, Carr M, Cullen NM, Morris R. Trophoblast in the circulating blood during pregnancy. Am J Obstet Gynecol 1959; 78:960-973.
4. Hankins GD, Wendel GD, Snyder RR, Cunningham FG. Trophoblastic embolization during molar evacuation: central hemodynamic observations. Obstet Gynecol 1987; 69:368-372.
5. Berek JS, Hacker NF. Berek & Hacker’s Gynecologic Oncology. Berkowitz RS, Goldstein DP. Chapter 15. “Gestational Trophoblastic Disease” page: 625-49, LWW, Sixth Edition, 2015.
6. Schmorl G. Pathologisch-anatomische Untersuchungen über Puerperal-Eklampsie. Verlag FCW Vogel, Leipzig; 1893.
7. Wagner D. Trophoblastic cells in the blood stream in normal and abnormal pregnancy. Acta Cytol 1968; 12:137-139.
8. Chatelain SM, Quirk JG Jr. Amniotic and thromboembolism. Clin Obstet Gynecol 1990; 33:473-481.
9. Twiggs LB, Morrow CP, Schlaerth JB. Acute pulmonary complications of molar pregnancy. Am J Obstet Gynecol 1979; 135:189-194.
10. Dey M, Dhawan M. Critical care management of molar pregnancy in a peripheral set-up. Med J Armed Forces India 2011; 67:385-387.
11. Ikarashi T, Takeuchi S, Ohnishi Y. Trophoblastic embolism in sudden maternal death. Nihon Sanka Fujinka Gakkai Zasshi 1988; 40:793-795.
12. Pritchard JA. Blood volume changes in pregnancy and the puerperium. IV. Anemia associated with hydatidiform mole. Am J Obstet Gynecol 1965; 91:621-629.