Maternal complications in molecularly confirmed diandric and digynic triploid pregnancies: single institution experience and literature review

D Massalska,A Kucińska-Chahwan,J Bijok,K Ozdarska,T Roszkowski,G M Panek,A Raniszewska,J G Zimowski

doi:10.1007/s00404-020-05515-4

Abstract

ObjectivesAssessment of the maternal complications in molecularly confirmed diandric and digynic triploid pregnancies.MethodsSonographic features, biochemical results, and clinical presentation were analyzed. Beta-hCG level was controlled after diandric triploidy.ResultsThe study included nine diandric and twelve digynic triploid pregnancies at the mean gestational age at diagnosis of 14.9 and 18.0 weeks, respectively (p = 0.0391). Mean value of total-hCG was 979 703.6 U/ml in diandric cases and 5 455.4 U/ml in digynic ones (p < 0.000). Maternal complications occurred in 88.9% of diandric triploid pregnancies, including: thecalutein cysts (44.4%), hyperemesis gravidarum (44.4%), symptomatic hyperthyreosis (33.3%), early onset gestational hypertension (22.2%) and vaginal bleeding (11.1%). No case of proteinuria, preeclampsia or HELLP syndrome was observed. Only maternal complication observed in digynic triploidy was vaginal bleeding (50.0%). The mean time of beta-hCG normalization after diandric triploid pregnancies was 84 days (range 11–142 days). No case of gestational trophoblastic neoplasia (GTN) was observed.ConclusionsMaternal complications (except for vaginal bleeding) are associated with diandric triploidy. The relatively low incidence of hypertensive maternal complications and their less severe course in our cohort may be attributed to the earlier prenatal diagnosis. The frequency of GTN after diandric triploidy may be lower than previously reported.

Highlights

Triploidy is a lethal chromosomal abnormality resulting from an extra haploid chromosome set of maternal or paternal origin [18]
In order to exclude gestational trophoblastic neoplasms (GTN) after diandric triploid pregnancies complicated by molar changes the beta-hCG level was controlled every 2 weeks till normal values and a single control follow-up measurement in a month to confirm normal results was performed according to the protocol suggested by Coyle et al [9]
We present a cohort of consecutive diandric and digynic triploid pregnancies with molecular confirmation that survived beyond 13 gestational weeks

Summary

Introduction

Triploidy is a lethal chromosomal abnormality resulting from an extra haploid chromosome set of maternal or paternal origin [18]. Pregnancy characteristics depend on parental contribution of the extra chromosomes. Diandric triploidy (type I) manifests with a relatively well-grown fetus with normal head size or microcephaly and enlarged. The majority of triploid pregnancies is miscarried at an early developmental stage. Triploidy occurs in around 0.03% of pregnancies at 10–14 gestational weeks and 0.002% of pregnancies at 16–20 weeks [14, 20]. Triploidy may cause maternal complications such as preeclampsia, hyperthyroidism, gestational trophoblastic neoplasia or vaginal bleeding [17, 29, 38]. Assessment of the risk for maternal complications depending on the parental origin of triploidy has not been performed to date

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