O risco de desenvolvimento de neoplasias após esquema de me- totrexato parece semelhante ao da população em geral, havendo discreto aumento de casos de leucemia associado ao uso de EMA-
CO, principalmente em tratamentos superiores a 6 ciclos36.
8.1
FERTILIDADE
As doentes devem ser tranquilizadas no sentido de poderem ter gestações futuras normais, não estando estas comprometidas mesmo após esquemas de poliquimioterapia (ex. EMA-CO), sendo
possíveis, nestes casos, em 86%37. No entanto, cerca de 1% das
gestações subsequentes resultarão em gestação molar. Este risco aumenta para 20% após terem ocorrido duas gestações molares. Preconiza-se, assim, a realização de uma ecograia pélvica precoce no primeiro trimestre nas gestações futuras para conirmação de gestação normal. Em gestações subsequentes, a placenta deve ser enviada para estudo anatomopatológico e a hCG deve ser avaliada às 6 e às 10 semanas pós-parto, altura em que deve ser indetetável. As doentes devem ser aconselhadas a aguardar pelo menos 1 ano após o término da quimioterapia para engravidar, sendo o método anticoncepcional de eleição a contraceção hormonal. Contudo, os poucos casos descritos em que a gravidez ocorreu durante o pri- meiro ano de seguimento não se associaram a maiores riscos para
feto, podendo ser considerada viável38.
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148
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NEOPLASIA TROFOBLÁSTICA GEST