Gestational trophoblastic disease (GTD) is a group of conditions characterized by
abnormal proliferation of placental trophoblast. Hydatidiform mole (HM) is the most
common form of GTD, which has a frequency of 1 case per 1,000 pregnancies in North
America and Europe; however, the incidence of the disease is thought to be at least
two to three times higher in Brazil.[1]
[2]
In developing countries, due to the delay in diagnosis of HM, it is not uncommon for
patients to develop clinical complications, which can represent causes of potentially
life-threatening conditions, maternal near miss and maternal deaths.[3] The only way to prevent those adverse outcomes is the early diagnosis of HM and
prompt uterine evacuation. After uterine evacuation, patients with HM need to be carefully
followed due to the risk of development of gestational trophoblastic neoplasia (GTN).
The early diagnosis of GTN is key to ensure cure, and patients with late diagnosis
of GTN require more aggressive and toxic treatment and hold worse prognosis, often
with metastatic disease.[1] Official national data on the morbidity and mortality rates of patients with GTD
is not available. Currently, a nationwide collaborative study is in progress to better
understand the morbidity and mortality of patients with GTN in Brazil, through the
Brazilian Network for Gestational Trophoblastic Disease Study Group, which has developed
several collaborative studies over the last years to advance the understanding of
GTD.[4]
[5]
The Comissão Nacional Especializada em DTG (Special National Committee on GTD), an
initiative of the Federation of Brazilian Associations of Gynecology and Obstetrics
(FEBRASGO), has been focusing on continued medical education through free online management
protocols and several national and regional teaching events with the Nation's leading
specialists.
The importance of reference centers in the management of patients with GTD has been
highlighted in various studies, showing that patients present better outcomes when
they are initially followed at those centers.[6] The GTD reference centers are able to follow and manage patients within the full
spectrum of GTD with a multidisciplinary team and a personalized approach. The Associação
Brasileira de Doença Trofoblástica Gestacional (Brazilian Association of Gestational
Trophoblastic Disease), over the last years, had the task to help to establish GTD
reference centers across the Nation. Currently, there are 47 centers in Brazil and
at least one in each of the Brazilian states, shortening the distance between the
patients and the treatment of excellence through the public health system.[7]
The official government referral system that refers patients in primary care to secondary
and tertiary care is one way for patients to reach a GTD reference center. However,
this referral system is far from being perfect, as many patients are referred late,
sometimes with severe complications. Therefore, making technology and social media
allies, the Associação Brasileira de Doença Trofoblástica Gestacional created a Facebook
page (currently with over 7,700 members, including patients, relatives and healthcare
providers) that helps patients reach the nearest reference center, find reliable information
of the disease online, and also serve as a patient support group.[8]
[9]
Gestational trophoblastic disease is a complex group of diseases. Their early diagnosis
and treatment are fundamental to achieve cure.[10] Brazil, being a country of continental dimensions, makes the task of treating patients
with such rare diseases very difficult. Therefore, several initiatives by Associação
Brasileira de Doença Trofoblástica Gestacional and Comissão Nacional Especializada
em DTG are in action and being implemented to foster the better care of patients with
GTD across the Nation.
