Hydatidiform Research Articles

How Could One Sperm and One Oocyte Proceed To Molar Pregnancy? Prevalence of Molar Pregnancy during ICSI Procedure in Over 25,000 Fresh Embryo Transfers: A Retrospective Cross-Sectional Study.

Gestational trophoblastic disease (GTD) is a heterogeneous group of diseases characterized by excessive proliferating trophoblastic tissue. The prevalence of GTD has a varied geographical distribution. However, its frequency following intracytoplasmic sperm injection (ICSI) cycles has not yet been reported. This study aimed to estimate GTD frequency and prevalence after ICSI cycles. This retrospective cross-sectional study included all patients diagnosed with GTD subsequent to ICSI and segmental embryo transfer procedure during 2011-2019 at Royan Institute. GTD diagnosis was established for patients who met all three criteria: beta-human chorionic gonadotropin (β-hCG) levels greater than 100,000 mIU/mL, vesicular ultrasonographic pattern, and presence of pathologic features of hydatidiform mole. Although we assessed the GTD frequency in all ICSI cycles, GTD cases were only observed following fresh embryo transfer ICSI procedures. We evaluated 25,667 fresh embryo transfer ICSI procedures out of 41,540 ICSI cycles. This study identified a total of 10 GTDs confirmed by all criteria which were mentioned previously. Of these 10 GTDs, nine cases had hydatidiform mole, and one had gestational trophoblastic neoplasia. The frequency of GTD was calculated 10 cases in 41,540 (0.240 per 1000) ICSI procedures and 10 in 25,667 (0.389 per 1000) fresh embryo transfers following ICSI cycles. Also, we detected 10 GTD cases in 8,196 (1.220 per 1000) clinical pregnancies. We discuss that the possibility of GTD after ICSI procedure is not as low as expected. Thus, the previous theses are insufficient to explain all aspects of molar pregnancy, and more research is required.

Clinical Features of Gestational Trophoblastic Disease in Aged Women in South Vietnam.

This study aimed to determine the occurrence rate of gestational trophoblastic neoplasia (GTN) and its related factors in aged women with hydatidiform mole (HM) in Tu Du Hospital, Vietnam. This retrospective cohort study included 372 women aged ≥40 years with HM diagnosed through post-abortion histopathological assessment in Tu Du Hospital from January 2016 to March 2019. Survival analysis was used for GTN cumulative rate estimation, log-rank test for group comparison, and Cox regression model for determining GTN-related factors. After a 2-year follow-up, 123 patients were found to have GTN at a rate of 33.06% [95% confidence interval (CI): 28.30-38.10]. GTN occurrence meant that the time was 4.15±2.93 weeks with peaks at week 2 and 3 after curettage abortion. The GTN rate was remarkably higher in the ≥46-year age group than in the 40-to-45-year age group [hazard ratio (HR)=1.63; 95%CI: 1.09-2.44], as was the vaginal bleeding group compared to the non-bleeding group (HR=1.85; 95%CI: 1.16-2.96). Preventive hysterectomy and preventive chemotherapy plus hysterectomy in the intervention group reduced the GTN risk compared to the no intervention group at HRs of 0.16 (95%CI: 0.09-0.30) and 0.09 (95%CI: 0.04-0.21), respectively. Chemoprophylaxis failed to decrease the GTN risk when comparing the two groups. Post-molar pregnancy GTN rate in aged patients was 33.06%, much higher than that of the general population. Preventive hysterectomy or chemoprophylaxis plus hysterectomy are effective treatment methods to support GTN risk reduction.

Molar pregnancy with a coexistent fetus following assisted reproductive techniques: Two case reports

Hydatidiform mole with the coexisting live fetus is a rare entity occurring in 0.005%–0.01% of all pregnancies. With the introduction of assisted reproductive techniques (ARTs), a significant rise in the incidence of multiple pregnancies has been reported. Here, we report two cases of molar pregnancies with a coexisting live fetus conceived following assisted conception. In our first case, pregnancy was continued and delivered a term live infant. The second case was aborted at 16 weeks' gestation due to maternal complications. These two patients needed chemotherapy due to persistent gestational trophoblastic disease. The rarity of this condition poses several diagnostic and management challenges, especially conceiving after ART the decision of termination for such couples.

Effectiveness of education program on nurses’ general knowledge about hydatidiform mole pregnancy

Objective: To determine the effectiveness of education program on nurses’ general knowledge about hydatidiform mole pregnancy. Material: This quasi-experimental study included nurses who worked in maternity units with application of pretest and posttest approach to evaluate the effectiveness of educational program on nurse's knowledge about hydatidiform mole. Results: Nurses had fair level of general knowledge during pre-test. During post-test 1and 2, they showed good level of knowledge. Conclusion: Nurse knowledge improved after educational program.

Renal effects of hydatiform mole and choriocarcinoma

Molar pregnancy is an abnormal growth of trophoblastic tissue in the uterus. It can be either complete or partial. In complete moles, the development of the fetus is absent, while partial moles contain an abnormal gestational sac. Choriocarcinoma is a malignant form that arise from molar tissue. Hydatiform mole and choriocarcinoma are rare and complicated diseases with numerous pathological conditions that can lead to significant kidney damage. Proteinuria, nephrotic syndrome, preeclampsia, decreased glomerular filtration rate, interstitial inflammation, crescentic glomerulonephritis, and thrombosis of the renal veins are the commonly encountered renal disorders with these diseases. Early intervention and treatment during pregnancy minimize these risks and lessen the risk of chronic kidney disease or end-stage renal failure. A multidisciplinary team approach involving obstetricians, nephrologists, pathologists, gynecologists, and radiologists is necessary for optimal management.

Nursing guidelines for Improving Maternity Staff Nurse Self-Efficacy regarding Caring with Pregnant Women suffering from Vesicular mole

Nursing guidelines for Improving Maternity Staff Nurse Self-Efficacy regarding Caring with Pregnant Women suffering from Vesicular mole

Nursing guidelines for Improving Maternity Nurses’ Self-Efficacy regarding Caring Women Suffering from Vesicular mole

Nursing guidelines for Improving Maternity Nurses’ Self-Efficacy regarding Caring Women Suffering from Vesicular mole

Outcomes of Gestational Trophoblastic Disease in King Khalid National Guard Hospital

Objective: The objective of this study is to review the outcomes of gestational trophoblastic disease in our center, and to compare it with international figures. We will calculate the rates of remission, recurrence, and mortality. Also, we will determine the mean duration taken for normalization of β-hCG level after initiation of treatment, and the distribution of the disease by age and parity. Methods: Retrospective chart review of the patients diagnosed with gestational trophoblastic disease (GTD) and treated in King Khalid National Guard Hospital in the period between January 2000 and December 2005. Results: During the study period, there were 29 cases of gestational trophoblastic disease. The majority of the cases were non-metastatic GTD (55.2%) followed by, in decreasing order of frequency, molar pregnancy (24.1%), metastatic high-risk GTD (10.3%), metastatic low-risk GTD (6.9%) and placental-site trophoblastic tumor (3.4%). Patient's age ranged from sixteen to fifty-three years old, with the majority in the fourth decade of life (37.9%). The parity as well was highly variable from zero to fifteen, with the majority between five and ten (37.9%). Remission rate in the malignant GTD was 85.7%. There were no cases of recurrence during the follow-up period. The overall mortality rate was 3.4%. The mean duration required for normalization of β-hCG level was 10.3 weeks for molar pregnancy and 11.6 weeks for malignant GTD. Conclusion: The chemotherapy success rate, remission rate & mortality rate were similar to that reported in earlier studies. There is a need for patient education regarding strict follow-up for early detection and intervention of malignant sequelae.

Incidence and risk factors of unanticipated pathology in cases of hysterectomy for benign lesion a cross-section study in Al Shifa Medical Complex

ObjectiveTo measure the incidence of unanticipated gynecologic malignancies among women who underwent hysterectomy for benign indications. MethodsWe conducted a data analysis of hysterectomy cases from the medical files as well as from pathology reports in the pathology department in Al Shifa Medical Complex. Cases were abstracted from 1st January 2019 to 30th December 2020. Preoperative surgical indications included abnormal uterine bleeding (AUB), fibroid, endometrial malignancy, ovarian mass, prolapse, molar pregnancy, and adenomyosis. ResultsDuring the study period, 195 women underwent a hysterectomy. More than 50% were performed for fibroid and abnormal uterine bleeding (AUB). The incidence of unanticipated gynecologic malignancy among hysterectomies performed for benign indications was 3.06% (6 cases). Three of them underwent hysterectomy due to post-menopausal bleeding with no preoperative endometrial sampling. Main risk factor were age, anemia, previous medical disorder, lack of equipments, and insufficient preoperative investigations or risks assessments that we considered it an important factor for the development and concealment of pre-existing malignant growth which will lead to future complicated medical plan and management to control the situation. ConclusionUnanticipated pathology in this study was mainly due to incomplete preoperative assessment and workup including diagnostic imaging modalities and D&C biopsy. This workup should be done for all cases before hysterectomy, especially in old-age women with postmenopausal bleeding. Our study indicates that even in cases that are expected to be benign, nothing should be overlooked, and detailed preoperative evaluations should be performed.

Socioeconomic Factors and Abortive Outcomes of Clinical Pregnancy After Embryo Transfer in the Setting of Universal Health Insurance Coverage of IVF.

In vitro fertilization-embryo transfer (IVF-ET), an expensive option for infertile couples, started to be fully covered by the National Health Insurance (NHI) from October 2017 in South Korea. We investigated the association between woman's socioeconomic status (SES) and abortive outcomes in pregnancies after IVF-ET in the setting of universal coverage of the treatment. Using the NHI database in South Korea, we conducted a retrospective cohort study of all women who achieved clinical pregnancy after ET between October 2017 and February 2019. A total of 44,038 clinical pregnancy episodes of 29,847 women who underwent ET were analyzed. We used employment status, income in percentiles, and living in the Seoul capital area as indicators of SES. Relative risks (RRs) for abortive pregnancy outcomes were calculated for each socioeconomic stratum, using log-binomial regression models included woman's age, body mass index, fasting blood glucose, fresh ET, month of ET, and history of smoking. While most pregnancy outcomes were live births (n = 30,783, 69.9%), 11,215 (25.5%) cycles ended with abortion or early pregnancy loss, 1,779 (4.0%) cycles were ectopic pregnancy, 45 (0.1%) were coded as molar pregnancy, and 224 (0.5%) were fetal death in utero or stillbirth. The risk of overall abortive outcomes was higher when a woman was unemployed (adjusted RR, 1.08; 95% confidence interval [CI], 1.05-1.11) or living in a non-Seoul capital area (1.11; 95% CI, 1.08-1.14). The association between relative income level and abortive outcomes was close to null. Living outside Seoul capital area was associated with the greater risk of abortive outcomes especially in younger women. Unemployment and living in non-capital areas were associated with a higher risk of abortive outcomes among pregnancies after ET, even in the setting of universal coverage of IVF-ET. This suggests potential impact of socioeconomic position on the IVF-ET pregnancy.

Partial Hydatidiform Mole and Coexistent Live Fetus with anencephaly: A Rare Case Report

Partial molar pregnancy is a rare entity in which there is usually a triploid abnormal fetus associated with a large placenta with cystic changes. The fetus is usually not compatible due to multiple abnormalities. Here we present a case of a 24-year-old pregnant woman who came for routine first trimester scan and was diagnosed with partial mole and a live fetus with anencephaly and multiple spinal anomalies.

The Immune Microenvironment of the Hydatidiform Mole and Invasive Mole

The Immune Microenvironment of the Hydatidiform Mole and Invasive Mole

Concerns of Self-induced Medical Abortion: Molar Pregnancy Diagnosed in Case of Incomplete Abortion

Concerns of Self-induced Medical Abortion: Molar Pregnancy Diagnosed in Case of Incomplete Abortion

Twin pregnancy: Live fetus with complete hydatidiform molar—A case report

Gestational trophoblastic disease encompasses a range of lesions, each culminating in varied clinical manifestations. Among these, the simultaneous occurrence of molar changes within the placenta and a viable fetus remains a particularly elusive and challenging presentation, posing intricate dilemmas for obstetricians. In this article, we delineate a distinct case involving a 21-year-old woman with a history of consanguineous marriage. She was referred from Médecins Sans Frontières to the Rafic Hariri University Hospital during her 19th week of gestation. With an unremarkable medical history and uncomplicated previous pregnancies, her presentation to the Rafic Hariri University Hospital was punctuated by symptoms of premature labor. Clinical evaluations revealed ruptured membranes, a fetus-positioned breech, and discernible complications tied to the placental morphology. Given these clinical findings, a decision was made in favor of a Cesarean delivery. Prior to this, the patient had been administered corticosteroids and tocolytics. Subsequent delivery produced a live male infant at 34 + 5 gestational days, and further assessment unveiled a complete molar pregnancy. The coexistence of a viable fetus alongside a complete molar pregnancy is an infrequently documented phenomenon, underlining the clinical significance of this case. A comprehensive literature survey reinforced the exceptional nature of our findings. Postpartum, both the mother and neonate were monitored for a month, ensuring their well-being. This case accentuates the paramountcy of prompt and precise diagnostic interventions when faced with atypical presentations. It further underscores the imperative for obstetricians to possess nuanced expertise in confronting the intricate challenges posed by gestational trophoblastic disease, ensuring optimal maternal and neonatal outcomes.

Ectopic Molar Pregnancy with Coexistent Normal Intrauterine Pregnancy: A Report of an Unusual Diagnosis managed in Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon

Ectopic Molar Pregnancy with Coexistent Normal Intrauterine Pregnancy: A Report of an Unusual Diagnosis managed in Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon

Epidemiological and morphological pattern of complete hydatidiform mole in Aminu Kano Teaching Hospital, Kano Northwestern Nigeria

Background: Complete hydatidiform mole (CHM) is the most common form of non-neoplastic gestational trophoblastic diseases (GTD) that is associated with progression to choriocarcinoma without prompt intervention. The objectives of this study is to morphologically analyze all cases of complete hydatidiform mole in Aminu Kano Teaching Hospital using set down criteria, look at the epidemiological pattern and compare with similar studies in order to stimulate proper identification from other forms of moles, hence reduce morbidity and mortality associated with the known complication of progressing to deadly Choriocarcinoma. Material and Methods: This was a retrospective study of all molar specimens submitted to Histopathology Pathology Department of Aminu Kano Teaching Hospital, Kano between 1st January 2015 and 31st December 2016. Formalin-fixed paraffin-embedded tissue blocks and corresponding Haematoxylin and Eosin (H&E) stained slides were retrieved. Cases with final diagnosis of complete mole were selected for further detailed microscopic evaluations. The collected data were presented using simple frequency tables and figures including photomicrographs of representative lesions. Results: There were sixty-seven cases of complete hydatidiform mole during the study period out of the 61,780 deliveries, giving an approximate incidence of 1:1000 deliveries in Kano metropolis and its environs. The peak incidence was observed in women between 20- 24 years of age with majority presenting between 11-14weeks of pregnancy. The ratio of complete to partial mole was approximately 3:1. Constant morphologic features associated with CHM includes; villous enlargement, trophoblastic hyperplasia, round shape chorionic villi and fibromyxoid stroma. Least prominent feature of CHM is myxoid stromal type. Conclusion: Complete hydatidiform occurs commonly in the gestational ages of between eleven to fourteen weeks; need histopathologic evaluations and prompt intervention to avoid consequences of both immediate complication such as invasive mole and long-term complication of choriocarcinoma. Keywords: Hydatidiform Mole, Complete Mole, Choriocarcinoma

A Rare Case of Large Hydatidiform Mole Mimicking a Term Pregnancy

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 and was followed up serial serum ß-hCG level. Therefore, complete mole can present with enlarged uterus, vaginal bleeding and anemia. It is also important to note that intractable bleeding following suction and evacuation not being controlled with uterotonics and antifibrinolytic agents and uterine artery ligation may require hysterectomy to save the patient’s life.

Understanding of already known fact: Evaluating frequency and determinants of Hydatidiform Molar Pregnancy

Introduction: Sporadic presentation of hydatidiform has been reported previously as 1 in 1000 pregnancies. In rare cases asymptomatic molar pregnancies can cause problems if not identified in early radiological investigations. The aim of this study is to evaluate the frequency of hydatidiform (molar pregnancy) presenting with associated symptoms, analysis of determinants and management in Sindh, Pakistan. Methodology: This is a cross sectional study, patients were divided into categories according to maternal age, gravida while Beta HCG values were reported along with radiological investigation reporting to confirm hydatidiform molar pregnancy. Statistical package of social science version 21 was used to analyze the data. Results: Total 51 patients were identified with hydatidiform molar pregnancy during study period of 12 months from more than 1000 full term reported pregnancies, indicating 5.1% prevalence of disorder. The diagnosis has been confirmed only 1 (1.9%) case of partial molar pregnancy while 50 (99.1%) were complete molar pregnancy cases, managed by suction evacuation method, risks factors of hydatidiform molar pregnancy with advanced maternal age, recurrent molar pregnancy and positive family history the odds ratio has indicated positive association between first two determinants with OR of 1.71 and 1.21 respectively. Conclusion: Overall recorded frequency of hydatidiform in our institute is 5.1% within 1 year. Advanced maternal age and previous history of molar pregnancies are risk factors of hydatidiform.

First Trimester Bleeding in Pregnancy within the Gynecology and Obstetrics Department of Sourô Sanou Teaching Hospital in BoboDioulasso: 422 Cases Studied and Literature Review

Objectives: Study the epidemiological, clinical, therapeutic and prognostic aspects of the first trimester bleeding of pregnancy. Methodology: This was a descriptive cross-sectional study conducted within the Gynecology and Obstetrics Department of Sourô Sanou Teaching Hospital from January 1st to December 31st, 2019. The study included any patients admitted and treated for endo uterine bleeding in pregnancy with a term inferior or equal to 15 weeks of amenorrhea. The parameters studied were the following: sociodemographic characteristics (age, parity, level of education, occupation, marital status, origin), clinical and paraclinical aspects, diagnosis retained, treatment, and maternal prognosis. Information was collected from a survey form, from clinical records, operating protocols and anatomopathological reports. Data entry and analysis was made through Word and Epi-info 7.2.3 software. Results: During the period of study, 422 cases of first trimester bleeding were reported, corresponding to a frequency of 10.33%. The average age was 29 ± 6.4 years [15-49 years] and the average parity was 1.95 ± 1.7 [0-11]. Married women accounted for 75% of the population. The average gestational age was 9.14 weeks of amenorrhea [5-14 weeks of amenorrhea]. Clinical signs were dominated by vulvar bleeding in 100% of cases and pelvic pains in 86% of cases. All our patients had gone through pelvic ultrasound. As for the diagnoses retained, these included: a threatened abortion in 11.84% of cases, an incomplete abortion (46.77% of cases), an ectopic pregnancy (EP) (26.8% of cases), a terminated pregnancy (17.9% the cases) and a molar pregnancy (8.3% of cases).Abortions were managed through MVA (68.27%) and medical abortion (4.8%). All the cases of EP were treated surgically and no maternal deaths were recorded in our study. Conclusion: First trimester bleeding in pregnancy is common within the department. The main etiologies are threatened abortion, incomplete abortion, molar pregnancy and ectopic pregnancy.

RARE CASE OF PARTIAL MOLE WITH LIVE FETUS PROGRESSION TO INVASIVE MOLE WITH LUNG METASTASIS FOLLOWING SPONTANEOUS CONCEPTION

Hydatiform mole belongs to a group of diseases classified as gestational trophoblastic disease,that results from an impaired fertilization.Moles have been divided into complete or partial moles on the basis of distinctive histopathological features and genetic abnormalities.Partial molar pregnancy with coexisting fetus is a rare complication with an incidence of 0.005%-0.01% of all the pregnancies.It usually derives from dispermic fertilization of all a haploid normal oocyte and produce a triploid set of chromosomes (69XXX69XXYor 69XYY)and is most commonly associated with the presence of a malformed fetus. We report a case of 21 year old primigravida with 19week +1dyay gestational age with pregnancy induced hypertension with? complete molar pregnancy with anemia presented to delivery room which was referred from private hospital in view of molar pregnancy for termination and correction of anemia.