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Obstetric outcomes after medroxyprogesterone acetate treatment for early stage endometrial cancer or atypical endometrial hyperplasia: a single hospital-based study

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Abstract

Background

To investigate perinatal outcomes in pregnancy after high-dose medroxyprogesterone acetate (MPA) therapy for early stage endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) and to determine whether pregnancy after MPA therapy is at a higher risk of placenta accreta.

Methods

Data of 51 pregnancies in 46 women who received MPA therapy for EC or AEH and delivered after 22 weeks of gestation at Keio University Hospital were reviewed. A retrospective matched case–control study was performed to determine the risk of placenta accreta in pregnancy after MPA therapy compared with singleton pregnancies without any history of maternal malignancy treatments.

Results

The incidence of placenta accreta was higher in the MPA group than in the control group (15.7 vs. 0%, p = 0.0058). However, no differences in other perinatal outcomes were observed between groups. While gestational weeks at delivery in the MPA group were later than those in the control group (p = 0.0058), no difference in the incidence of preterm delivery was recorded between groups. In the MPA therapy group, the number of patients who underwent ≥ 6 dilation and curettage (D&C) was higher in the placenta accreta group than in the non-placenta accreta group (50.0 vs. 14.0%, p = 0.018). Patients with ≥ 6 D&Cs demonstrated a 6.0-fold increased risk of placenta accreta (p = 0.043, 95% CI 1.05–34.1) than those receiving ≤ 3 D&Cs.

Conclusion

Pregnancy after MPA therapy is associated with a high risk of placenta accreta. In cases in which the frequency of D&C is high, placenta accreta should be considered.

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Data availability

The datasets generated and analyzed during this study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank all medical staff in the obstetric units of Keio University Hospital for excellent patient care. We would like to thank Editage (www.editage.jp) for English language editing.

Funding

This study was supported by the JSPS KAKENHI (Grant No. 20K18173).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan

    Maki Oishi, Yoshifumi Kasuga, Yuka Fukuma, Asuka Hamuro, Junko Tamai, Yuya Tanaka, Keita Hasegawa, Takuma Yoshimura, Satoru Ikenoue, Daigo Ochiai, Wataru Yamagami & Mamoru Tanaka

  2. Department of Obstetrics and Gynecology, School of Medicine, Kitasato University, 1-15-1, Kitasato, Minami-Ku, Sagamihara-Shi, Kanagawa, 252-0375, Japan

    Daigo Ochiai

Authors
  1. Maki Oishi
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  2. Yoshifumi Kasuga
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  3. Yuka Fukuma
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  4. Asuka Hamuro
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  11. Wataru Yamagami
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  12. Mamoru Tanaka
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Contributions

MK collected the data, wrote the manuscript, contributed to the discussion, and reviewed and edited the manuscript. YK and WY wrote the manuscript, contributed to the discussion, and reviewed and edited the manuscript. YT, AH, JT, YT, KH, TY, SI, and DO contributed to the discussion, and reviewed and edited the manuscript. MT supervised.

Corresponding author

Correspondence to Yoshifumi Kasuga.

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The authors report there are no competing interests to declare.

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Oishi, M., Kasuga, Y., Fukuma, Y. et al. Obstetric outcomes after medroxyprogesterone acetate treatment for early stage endometrial cancer or atypical endometrial hyperplasia: a single hospital-based study. Int J Clin Oncol 28, 587–591 (2023). https://doi.org/10.1007/s10147-023-02297-y

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  • DOI: https://doi.org/10.1007/s10147-023-02297-y

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