20-year experience of managing profuse bleeding in gestational trophoblastic disease.

Objective: To review the outcomes of different methods in the treatment of severe bleeding or acute abdomen in gestational trophoblastic disease (GTD).

Study Design: In a tertiary referral center, the records of patients diagnosed with GTD and presenting with heavy vaginal bleeding or acute abdomen between January 1986 and December 2005 were retrieved.

Results: Seventeen patients presenting with heavy bleeding or acute abdomen and requiring emergency management were identified. Ten patients had heavy vaginal bleeding, and 7 had shock or signs of hemoperitoneum. Eleven patients had total abdominal hysterectomy with or without bilateral salpingo-oophorectomy (TAH +/- BSO), 2 had arterial ligation, 3 had embolization, and 1 had suturing of a vaginal defect due to a metastatic nodule. The median ages of the patients having TAH +/- BSO and other conservative treatments were 37 (21-52) and 32.5 (26-48), respectively. Fifteen patients received chemotherapy after surgical treatment. All patients survived except 1, who died of concurrent disease.

Conclusion: Profuse bleeding in GTD is rare. Hysterectomy, arterial ligation and angiographic embolization can effectively treat this condition. With more experience, angiographic embolization should be the treatment of choice, especially for those who are hemodynamically stable and wish to retain their fertility potential.