Fertility preserving treatment in a nulliparous with a molar pregnancy: a case report (original) (raw)
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European Journal of Obstetrics & Gynecology and Reproductive Biology, 1997
Ob/eetive: The current study was undertaken in order to identify the clinical characteristics and natural history, as well as methods of investigation and available therapy, of persistent gestational trophoblastic disease (GTD) following the evacuation of partial hydatidiform mole (PM). Methods': Case reports of persistent GTD following the evacuation of partial mole, were searched using the Medline computerized retrieval system. There were 66 such cases (including 4 cases treated at our department), representing 2.9% of GTD following PM. Results: The mean age of the women at diagnosis was 28.4 years and mean gravidity was 2.99. The mean gestational age at diagnosis was 15.5 weeks and the mean uterine size was 13.6 weeks. The most common presenting symptom was vaginal bleeding. In the majority of the patients, the pre-evacuation diagnosis was incomplete or missed abortion. Conclusions: Although the malignant potential of PM is low, persistent GTD may develop after PM and may even metastasize, it is usually responsive to single agent chemotherapy but may require combination chemotherapy. Therefore, after evacuation of PM, these women should be followed with serial serum b-hCG. Further research is needed to enable earlier identification of PM that eventually will develop persistent GTD.
Recurrent partial hydatidiform mole: a report of a patient with three consecutive molar pregnancies
International Journal of Gynecological Cancer, 2006
Hydatidiform mole (HM) is the most common form of gestational trophoblastic neoplasia and is characterized by atypical hyperplastic trophoblasts and hydropic villi. Recurrence of HM is extremely rare. Here, we report the case of a patient with three consecutive partial HMs without normal pregnancy. A 28-year-old woman with gravida 3, para 0, was referred to our hospital with a diagnosis of an invasive mole in December 2003. She had three consecutive molar pregnancies in 2000, 2001, and 2003. All three molar pregnancies were evacuated by suction curettage and the patient was followed by serial β-human chorionic gonadotropin levels. All three moles were histologically confirmed as partial moles. In the first two molar events no additional treatment after evacuation was required, but in the last event, the β-human chorionic gonadotropin levels increased and an invasive mole was suspected. Diagnostic workup ruled out an invasive mole and choriocarcinoma. Karyotypic analysis of the patient and her husband was normal. The patient required chemotherapy for treatment of persistent disease. Recurrent partial HM is a very rare clinical disorder. Repetitive molar pregnancy is not an indication for chemotherapy, but persistent disease does require chemotherapy.
Clinical Findings of Multiple Pregnancy With a Complete Hydatidiform Mole and Coexisting Fetus
Journal of Ultrasound in Medicine, 2010
The aim of this series was to evaluate the clinical features, management, and outcomes of multiple pregnancy with a complete hydatidiform mole and coexisting fetus (CHMCF). Methods. Between 1998 and 2008, we investigated 6 women with a diagnosis of a CHMCF. The gestational age at diagnosis, symptoms, serum b-human chorionic gonadotropin levels, cytogenetic and molecular analysis findings, complications, routes of delivery, and pregnancy outcomes were assessed. Results. All cases were diagnosed before 14 weeks' gestation by sonography. Only 1 ended with the delivery of a live-born neonate, whereas the other 5 cases required termination of pregnancy (TOP) before 21 weeks' gestation because of severe maternal complications (eg, preeclampsia, thyrotoxicosis, lung metastasis, and heavy bleeding) or intrauterine fetal death. The pathologic diagnosis of a complete hydatidiform mole was confirmed in all cases. Two patients required methotrexate for treatment of persistent trophoblastic disease (PTD). Conclusions. On the basis of our experience, in cases with a normal karyotype and no gross fetal abnormalities on sonography, we carefully recommend continuation of pregnancy as long as maternal complications are absent or controllable. However, updated treatment criteria are still needed, and intensive maternal follow-up is necessary in the postpartum period because maternal complications during pregnancy and PTD after TOP are not uncommon.
Oncology Letters, 2015
Partial hydatidiform mole and coexisting fetus (PHMCF) is a rare condition that presents a dilemma for physicians and the parents of the fetus, particularly when PHMCF is detected during the second trimester of pregnancy. The present study reports a case of PHMCF terminated by induction of labor via administration of Rivanol at 17 weeks. Follow-up measurements of serum β-human chorionic gonadotropin (β-HCG) levels, as well as imaging studies, indicated the presence of persistent trophoblastic disease (PTD) and lung metastases. The patient was therefore admitted for three courses of chemotherapy. Subsequently, the metastases receded and β-HCG levels decreased to within the normal range. The patient demonstrated no disease recurrence for 1 year. Following a review of the relevant literature, to the best of our knowledge, all PHMCF cases terminated by medical induction of labor during the second trimester resulted in the development of PTD and lung metastases. However, three cases of PHMCF that were terminated by caesarean section during the third trimester did not develop PTD or metastases. The present study therefore hypothesized that medical termination may not be a safe therapeutic strategy for the treatment of PHMCF during the second trimester, and that pregnancy should be allowed to continue empirically.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Partial hydatidiform mole and coexisting foetus is a rare condition, with an incidence of 122,000-1,000,000 pregnancies. It presents a dilemma for obstetricians when detected in second trimester of pregnancy. Medical termination is effective during second trimester; however, it increases the risk of occurrence of persistent trophoblastic disease. Following a review of literature, it was seen that most of the PHMCF terminated by medical induction during second trimester resulted in the development of PTD and lung metastasis. However, cases terminated by caesarean section during the third trimester did not develop PTD or metastasis. A 34 year old woman, gravida 3 para 2 at 25 weeks and 3 days of gestation, presented with absent fetal movements. She was markedly pale. She had no prior antenatal visits. Ultrasound examination revealed a single intrauterine foetus at 23 weeks of gestation with no cardiac activity. Spalding sign was positive. Liquor was reduced and showed internal echoes,...
A Rare Case of Large Hydatidiform Mole Mimicking a Term Pregnancy
Kathmandu University Medical Journal
Molar pregnancy is a type of abnormal pregnancy that usually presents with amenorrhea, vaginal bleeding and elevated serum ß-hCG levels. We report a rare case of complete hydatidiform mole occurring in a 46-year-old P2L2 lady who presented with a term size uterus and elevated serum ß-hCG level (> 15,00,000 per deciliter, anemia (hemoglobin: 8.1 g/dL), difficulty in breathing and minimal vaginal bleeding. During the course of her evaluation, she had profuse vaginal bleeding, she underwent suction and evacuation, but bleeding was not controlled despite measures to control it. She was given uterotonics and antifibrinolytic agents and uterine artery ligation. But was proceeded with emergency hysterectomy for uncontrolled hemorrhage. The content of suction and evacuation was vesicles with blood clots and histopathology was reported as complete hydatidiform mole. The patient received a total of 4 units of packed red blood cells. She was discharged from hospital on 5th postoperative day...
American journal of clinical pathology, 1996
The authors studied the prevalence and significance of implantation site trophoblastic atypia in hydatidiform moles and spontaneous abortions. Three pathologists independently categorized 99 early abortion specimens regarding diagnosis (spontaneous abortion, partial hydatidiform mole, complete hydatidiform mole); qualitative atypia of implantation site trophoblast (absent, mild, moderate-severe); and quantitative atypia of implantation site trophoblast (absent, focal, diffuse). Interobserver agreement was good to excellent regarding diagnosis (kappa 0.66-0.79) and poor to fair regarding qualitative atypia of implantation site trophoblast (kappa 0.20-0.43). By consensus diagnosis, implantation site trophoblastic atypia was mild and focal in 5% of 22 spontaneous abortions; predominantly focal in 40% of 30 partial moles (33% mild atypia; 7% moderate-severe atypia); and, predominantly diffuse in 87% of 47 complete moles (21% mild atypia; 66% moderate-severe atypia). Among hydatidiform m...
Complete Hydatidiform Mole with Co-existing Live Fetus: A Case Series
Journal of Fetal Medicine, 2015
This review was undertaken to evaluate the maternal and fetal risk associated with complete hydatidiform mole with co-existing fetus (CHMF) and to assess the feasibility for continuing such pregnancies. Twin gestations with CHMF were reviewed from the hospital database from 2005 to 2014 at our center. Diagnosis was based on ultrasonography and confirmed post-delivery, histopathologically. Amniocentesis for karyotype was done for the live fetuses. Serum b-hCG levels were followed till they normalized. Six cases of CHMF were salvaged from the archives. Three had live normal babies (50 %), pregnancy was terminated in two cases for excessive bleeding (33.3 %) and one miscarried (16.7 %). One fetus exhibited 47, XXY Klinefelter syndrome while rest showed normal karyotype. Two patients required blood transfusion, one was complicated with severe pre-eclampsia whereas none showed gestational trophoblastic neoplasm. CHMF is a rare condition that can be diagnosed by ultrasonography. Continuation of such a pregnancy is an acceptable option and expectant management instead of therapeutic abortion can be pursued after weighing the possibility of fetal survival against maternal risk. Counseling of the couple and family plays a crucial role. Associated spectrum of maternal and fetal complications mandates close pre-and post-natal surveillance.
Journal of SAFOG, 2014
Gestational trophoblastic disease encompasses a diverse group of lesions. If molar changes in the placenta are known along with an alive fetus, then situation is difficult for both obstetrician and parents. On one hand, there may be a normal pregnancy whereas on the other hand the mother may be threatened by numerous complications caused by the hydatid mole, if the pregnancy is continued. We present successfully managed case of partial molar pregnancy with an alive fetus at 1st stage of preterm labor with premature rupture of membranes with anemia with a live diploid female fetus with good neonatal out come. Follow-up till 1 year showed no progression to malignant gestational trophoblastic diseases.
Journal of Assisted Reproduction and Genetics, 2018
Benign hydatidiform mole, complete or partial, is the most common type of gestational trophoblastic disease (GTD) characterised by excessive trophoblastic proliferation and abnormal embryonic development. Although most complete hydatidiform moles (CHMs) are diploid androgenetic, a few cases of CHMs are biparental, characterised by recurrence and familial clustering. In these rare cases, mutations in NLRP7 or KHDC3L genes, associated with maternal imprinting defects, have been implicated. Current data regarding future pregnancy options in hydatidiform moles are discussed and our opinion is presented based on an incidence that took place in our hospital with a woman with consecutive molar pregnancies. In recurrent hydatidiform moles, DNA testing should be performed and when NLRP7 or KHDC3L mutation are detected, oocyte donation should be proposed as an option to maximise woman's chances of having a normal pregnancy.