Discussões com os pacientes
A adesão rigorosa à contracepção é aconselhada após a conclusão do tratamento.[3]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.
https://www.gynecologiconcology-online.net/article/S0090-8258(21)01421-9/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/34686354?tool=bestpractice.com
[34]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.
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.16266
[54]Faculty of Sexual & Reproductive Healthcare. FSRH GL on contraception after pregnancy. Jan 2017 [internet publication].
https://www.fsrh.org/standards-and-guidance/documents/contraception-after-pregnancy-executive-summary-document
A maioria dos métodos de contracepção, inclusive contraceptivos orais, pode ser usada com segurança após o tratamento para DTG e pode ser iniciada imediatamente após o esvaziamento uterino.[55]Braga A, Maestá I, Short D, et al. Hormonal contraceptive use before hCG remission does not increase the risk of gestational trophoblastic neoplasia following complete hydatidiform mole: a historical database review. BJOG. 2016 Jul;123(8):1330-5.
https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.13617
http://www.ncbi.nlm.nih.gov/pubmed/26444183?tool=bestpractice.com
[56]Dantas PRS, Maestá I, Filho JR, et al. Does hormonal contraception during molar pregnancy follow-up influence the risk and clinical aggressiveness of gestational trophoblastic neoplasia after controlling for risk factors? Gynecol Oncol. 2017 Nov;147(2):364-370.
http://www.ncbi.nlm.nih.gov/pubmed/28927899?tool=bestpractice.com
No entanto, os dispositivos intrauterinos (com medicamento ou não) são contraindicados em mulheres com tumores ativos e invasivos ou níveis de hCG persistentemente elevados, devido ao risco de perfuração uterina.[54]Faculty of Sexual & Reproductive Healthcare. FSRH GL on contraception after pregnancy. Jan 2017 [internet publication].
https://www.fsrh.org/standards-and-guidance/documents/contraception-after-pregnancy-executive-summary-document