Hydatidiform Research Articles

Clinicopathological Features of Gestational Trophoblastic Neoplasia (GTN): Single Institutional Study

Introduction: The term "gestational trophoblastic neoplasia" (GTN) refers to abnormal proliferation of trophoblastic tissue and occurs during pregnancy. It includes hydatiform mole, invasive mole, choriocarcinoma, placental site trophoblastic tumour and epitheliod trophoblastic tumour. Patients and Methods: This retrospective study was conducted at the Department of radiology, Peoples Medical College, Hospital, Nawabshah, Shaheed Benazirabad, Sindh; the clinical & ultrasonographic records of biopsy-proven cases of gestational trophoblastic disease registered in the department from January 1, 2019, to December 31, 2020 was evaluated and analysed through SPSS. Results: Total of 137 patients of biopsy proven gestational trophoblastic tumor was registered during the period. The age of the patient ranges between 15 to 50 years, the disease is most common in 21 to 30 years of age. Majority of patients belong to the rural areas (73%) in comparsion to urban area (26%).The most common tumor was hydatiform mole (76% ) followed by choriocarcinoma Conclusion: Gestational trophoblastic neoplasia are common disease in females of 21 to 30 years of age and hydatiform mole is the most frequent tumor type Keywords: Gestational trophoblastic disease, Hydatiform Mole, Malignancy, Ultrasound.

The Rare Association of Ectopic Pregnancy and Hydatidiform Mole: A Case Report

An ectopic molar pregnancy is a rare event, occurring in 1 in every 20,000–100,000 pregnancies. The condition may present as a complete or partial molar pregnancy and the ectopic site can vary as in a non-molar ectopic pregnancy. When a molar pregnancy presents as a tubal ectopic pregnancy, the risks related to both conditions, including tubal rupture and progress to malignancy, are compounded. The definitive diagnosis is normally reached by histopathology of the surgical specimen, since imaging tests are usually unable to differentiate between a molar and a non-molar ectopic pregnancy. While the specific histological findings may confirm the diagnosis of hydatidiform mole, immunohistochemistry is essential to differentiate between a complete and a partial molar pregnancy. Although in the majority of cases surgical resection is considered the definitive treatment, it is estimated that 20% of patients with a molar pregnancy may develop gestational trophoblastic neoplasia, hence requiring a risk-specific follow-up. This report describes a case of a tubal molar pregnancy and includes a review of clinical, diagnostic and therapeutic aspects, as well as a discussion on the particularities of this rare association.

Genetic screening of Chinese patients with hydatidiform mole by whole-exome sequencing and comprehensive analysis.

We aim to explore if there are any other candidate genetic variants in patients with a history of at least one hydatidiform mole (HM) besides the well-known variants in NLRP7 and KHDC3L. The diagnosis of HM type was based on histopathology, and available HM tissues were collected for short tandem repeat (STR) genotyping to verify the diagnosis. DNA extracted from blood samples or decidual tissues of the 78 patients was subjected to whole-exome sequencing (WES). We identified five novel variants in NLRP7, two novel variants in KHDC3L, and a chromosome abnormality covering the KHDC3L locus among patients with HM. We found that patients with HM who carried heterozygous variants in KHDC3L had a chance of normal pregnancy. We also detected four novel genetic variants in candidate genes that may be associated with HM. Our study enriched the spectrum of variants in NLRP7 and KHDC3L in Chinese HM patients and provided a new outlook on the effects of heterozygous variants in KHDC3L. The novel candidate genetic variants associated with HMs reported in this study will also contribute to further research on HMs.

Association of extended culture to blastocyst and pre-malignant gestational trophoblastic disease risk following IVF/ICSI-assisted reproduction cycles: an analysis of large UK national database.

To assess whether there is an association between extended in vitro culture based on embryo developmental stage at transfer and pre-malignant gestational trophoblastic disease (GTD) risk of molar pregnancy during assisted reproduction. A retrospective study was carried out using Human Fertilization and Embryology Authority (HFEA) anonymized register from 1999 to 2016. A total of 540,376 cycles were eligible to be included in the study after excluding any kind of donor treatment or surrogacy, frozen embryo transfers, and cycles with incomplete data. Subgroup analysis was carried out in subjects with primary infertility aiming to exclude an increased risk in those with a previous GTD. Multivariate logistic regression analysis was used to adjust for possible confounders, and the effect of day of embryo transfer in IVF (in vitro fertilization)/ICSI (intracytoplasmic sperm injection) treatment on a molar pregnancy GTD outcome was analyzed. The prevalence of a molar pregnancy GTD among the study population was 3.4/10,000 livebirths (53/156,683) with a higher risk in the over 40 age category. No significant difference of pre-malignant GTD incidence was seen between IVF and ICSI (0.01% vs 0.009% respectively). No association was seen with GTD based on type/cause of infertility or number of embryos transferred. Crude (1.06; 95% CI 0.852-1.31) and adjusted (1.07; 95% CI (0.857-1.32) odds ratios were calculated to see an association between day of embryo transfer and the occurrence of a GTD. There was no association between day of embryo transfer and molar GTD risk after adjusting for age and secondary infertility. No significant association between pre-malignant molar gestational trophoblastic disease and extended in vitro embryo culture was found after analyzing 540,376 cycles of IVF and ICSI.

Misdiagnosis of epithelioid trophoblastic tumors: a case report and literature review

Background: The most common clinical types of gestational trophoblastic neoplasia are invasive hydatidiform mole and choriocarcinoma, which can be diagnosed without pathology, and be cured by chemotherapy. Epithelial trophoblastic tumor, a rare type of gestational trophoblastic neoplasia, does not exhibit precise clinical manifestations upon auxiliary examinations. Therefore, since epithelial trophoblastic tumors are prone to misdiagnoses and missed diagnoses, their diagnosis have to be confirmed through pathology and immunohistochemistry. Case: We describe a case of a 37-year-old woman that had been misdiagnosed at a local hospital after she had presented with irregular vaginal bleeding and elevated human chorionic gonadotropin. The initial diagnosis was ectopic pregnancy and she was subjected to left salpingectomy, however, after treatment, there was no significant drop in human chorionic gonadotropin. Later, she was diagnosed with gestational trophoblastic neoplasia and was treated with multiple chemotherapy and hysterectomy. However, after treatment, her human chorionic gonadotropin was found to repeatedly fluctuate. Eventually, pathological examination of a resected lung lesion confirmed the presence of epithelial trophoblastic tumors. Conclusions: Epithelial trophoblastic tumor is an intermediate trophoblastic tumor that is not sensitive to conventional chemotherapy. Surgical resection is the recommended therapeutic option. Gestational trophoblastic neoplasia patients presenting with persistently low levels of human chorionic gonadotropin and resistance to conventional chemotherapy should, therefore, be considered for early surgical resection, or tissue biopsy to pathologically confirm the diagnosis and inform treatment options.

Pregnancy loss after in vitro fertilization and related factors

ABSTRACT Introduction: After getting pregnant by in vitro fertilization (IVF), pregnancy loss is one factor that prevents the baby from being born. An estimated 80% of pregnancy loss occurs in the first trimester, which is higher than in the natural pregnancy. The reason is said to be that the age of women receiving fertility treatment is often higher, leading to ovarian reserve, and decreased oocyte quantity and quality. However, studies on the pregnancy loss rate in Vietnam are still hard, and global studies still do not provide a complete consensus on the factors affecting this rate. This study aims to evaluate the pregnancy loss rate 12 weeks after in vitro fertilization and find some related factors. Methods: A cross-sectional descriptive study in embryo transfer patients after IVF treatment at Department of Assisted Reproduction in Hue Central Hospital was done from January 2020 to May 2021. Criteria for selection are pregnancy after embryo transfer (βhCG ≥ 25 UI/L after 14 days of embryo transfer) and having ultrasound monitoring up to 12 weeks gestation. Exclusion criteria include donor eggs, multifetal pregnancy reduction and ectopic pregnancy or hydatidiform mole. Results: There are 42 cases of pregnancy loss up to 12 weeks gestation in 133 pregnancies (βhCG ≥ 25 UI/L), equivalent to 31.6%. Among them were 9 cases of biochemical pregnancy, and 33 cases of pregnancy loss when having clinical pregnancy. The rate of at least one developing fetus to 12 weeks gestation is 102/133, equivalent to 76.7%. The pregnancy loss rate was statistically significantly lower in the group with endometriosis ≥ 10 mm before the embryo transferring date. Conclusion: Pregnancy loss after IVF is an issue that needs to be studied with a larger sample size to deeply understand the influencing factors to optimize the outcome of embryo transfer.

Laparoscopic Management of Partial Molar Caesarean Scar Ectopic Pregnancy

To demonstrate laparoscopic management of a molar scar ectopic pregnancy. Stepwise demonstration of the technique with narrated video footage. Cesarean scar ectopic pregnancy and molar pregnancy are 2 separate extremely rare pathologies with an incidence range from 1/1800 to 1/2500 of all pregnancies for the former [1,2]. The concurrence of both cesarean scar ectopic and molar pregnancy is furthermore exceptionally rare, and there are only 8 reported cases of cesarean scar molar pregnancy in literature till date [3]. There is a high risk of uterine rupture, uncontrolled hemorrhage, hysterectomy, and significant maternal morbidity owing to thin myometrium and fibrous scar after cesarean section [4,5]. Knowledge and awareness about this clinical condition aid in early diagnosis and reduced morbidity. Here, we present a rare case of cesarean scar ectopic pregnancy that was operated for failed medical management and diagnosed to be molar scar ectopic pregnancy intraoperatively. Total laparoscopic approach to molar scar ectopic pregnancy excision involved the following steps, strategies to minimize blood loss, and complete enucleation of tissue: (1) Hysteroscopy to localize the scar ectopic and its type and size (2) Bladder dissection to expose scar (3) Intramyometrial injection of vasopressin (4) Use of harmonic scalpel to delineate the gestational sac (5) Complete evacuation of products of conception (6) Excision of scar tissue (7) Uterine repair in 2 layers CONCLUSION: There are only 8 reported cases of cesarean scar molar pregnancy in literature till date, and all patients had at least 2 previous uterine curettages with abnormally increased β-hCG levels. The clinical manifestations were varied, the most common symptom being vaginal bleeding for a period >1 month, including our case [3]. Considering the limitations of ultrasound, magnetic resonance imaging, and serum hCG levels in the differential diagnosis of molar cesarean scar pregnancy from normal cesarean scar pregnancy, postoperative specimen should be sent for histologic examination [6]. As seen in our case, the possibility of molar pregnancy at cesarean scar ectopic site should be kept in mind in cases with rising β-hCG levels despite continuous medical interventions, which was being medically managed for 3 months. Our case is the first to be successfully managed with laparoscopic surgery as the previously reported cases were managed with suction evacuation, chemotherapy, laparotomy, or hysterectomy [3].

TSH Receptor Antibody Testing in Early Pregnancy.

Graves disease (GD) is the leading cause of hyperthyroidism in women of childbearing age, and thus, low serum thyrotropin (TSH) during pregnancy might be expected to be largely secondary to GD. This is not the case for 2 reasons. First, autoimmunity frequently abates during pregnancy, including thyroid-specific autoimmunity (1), so that even those with previously diagnosed GD may go into remission during pregnancy. Second, the physiology of thyroid hormone regulation is altered as a result of the agonist activity of β-human chorionic gonadotropin (βhCG) at the TSH receptor (2). Under normal conditions this leads to a slight increase in thyroid hormone production, which is independent of pituitary TSH secretion. Serum TSH levels fall, resulting in a left shift of the TSH reference range in pregnancy, and a lower limit of 0.1 mU/L in most assays (3). In early pregnancy especially, elevations of serum βhCG above those typically seen can cause a further rise in serum free thyroxine and more dramatic suppression of the serum TSH, resulting in “gestational transient thyrotoxicosis” (GTT) (3). This is typically mild and resolves after the first trimester, and is not associated with adverse pregnancy outcomes (4). The very high levels of βhCG found in hyperemesis gravidarum are associated with more severe biochemical thyrotoxicosis, and extremely high levels seen with molar pregnancy and choriocarcinoma can require antithyroid drug therapy and other measures to mitigate thyrotoxicosis. Indeed, persistent thyrotoxicosis during pregnancy from any cause, especially GD, has been associated with poor outcomes including fetal loss, maternal heart failure, and preeclampsia (5).

Uterine Rupture due to Gestational Trophoblastic Neoplasia on Nulliparous Woman : A Case Report

Background : Invasive mole (IM) is a frequent complication of gestational tropoblastic neoplasia (GTN). These tissues invade the myometrium deeply, occasionally affecting the peritoneum or vaginal vault. The prevalence of an invasive mole causing uterine rupture is uncommon. Case Report : We discuss the case of a 46-year-old nulliparous woman who presented to the emergency room complained severe abdominal pain that had been present for 4 hours. Patient had a history of complete mole evacuation 2 months ago with persistently elevated beta-human chorionic gonadotropin (B-HCG). . The patient was diagnosed with suspected uterine rupture due to an invasive mole  and advised to undergo hysterectomy. Total abdominal hysterectomy was performed with the preservation of both ovaries. Choriocarcinoma was diagnosed histopathologically, and the patient was prepared for chemotherapy using EMA-CO protocols. Conclusion : Perforation of the uterus by an invasive mole is a rare but lethal complication. Although hysterectomy followed by chemotherapy is the standard treatment for this condition, several studies demonstrate the benefit of conservative management in terms of fertility preservation in reproductive-aged women.

Emergency department point-of-care ultrasound diagnosis of a complete molar pregnancy presenting as first trimester bleeding.

Emergency department point-of-care ultrasound diagnosis of a complete molar pregnancy presenting as first trimester bleeding.

Molecular profiling of gestational trophoblastic neoplasia: Identifying therapeutic targets (167)

Objectives: The molecular characterization of gestational trophoblastic neoplasia (GTN), a rare disease, has been limited by the lack of tumor specimens. Despite the recent use of immunotherapy, women with recurrent or chemo-resistant diseases have limited treatment options. Our objective was to describe the molecular landscape of GTNs and identify potential therapeutic targets. Methods: A total of 30 GTN tumor samples were analyzed using next-generation sequencing (NGS) or whole-exome sequencing (WES) and immunohistochemistry (IHC). PD-L1 IHC used SP-142 (cut-off ≥1%). MSI was tested by fragment analysis, IHC, and NGS. TMB was measured by totaling somatic mutations per tumor (high ≥10 mutations per MB). Statistical significance was determined by Chi-square and p-values adjusted for multiple comparisons (q) to be < 0.05. Results: Thirty cases of GTN consisted of 15 choriocarcinomas, three complete moles, seven epithelioid trophoblastic tumors (ETT), and five placental site trophoblastic tumors (PSTT) were included in the study. The median age was 41.5 years (range 26-69), and the majority (56.7%) were primary tumors. PD-L1 IHC was positive in 28/29 (96.6%) of cases while nearly all cases were TMB low (15/16, 93.8%) and microsatellite stable (MSS) (17/17, 100%). TP53 mutations were the most common, occurring in 33.3% of choriocarcinoma cases. Homologous recombination repair (HRR) pathway alterations were identified in 13.3% of choriocarcinoma cases. RTK-RAS pathway was altered in 2/5 (40%) ETT cases and 1/14 (7.1%) choriocarcinoma cases (Table 1). Conclusions: Data is consistent with previously published literature demonstrating high PDL1 expression across GTN subtypes, strongly supporting a role for checkpoint blockade. Potential alternate targeted therapies for recurrent or chemoresistant GTN include Wee1, PARP, MEK inhibitors targeting TP53, HRR, and KRAS alterations. Objectives: The molecular characterization of gestational trophoblastic neoplasia (GTN), a rare disease, has been limited by the lack of tumor specimens. Despite the recent use of immunotherapy, women with recurrent or chemo-resistant diseases have limited treatment options. Our objective was to describe the molecular landscape of GTNs and identify potential therapeutic targets. Methods: A total of 30 GTN tumor samples were analyzed using next-generation sequencing (NGS) or whole-exome sequencing (WES) and immunohistochemistry (IHC). PD-L1 IHC used SP-142 (cut-off ≥1%). MSI was tested by fragment analysis, IHC, and NGS. TMB was measured by totaling somatic mutations per tumor (high ≥10 mutations per MB). Statistical significance was determined by Chi-square and p-values adjusted for multiple comparisons (q) to be < 0.05. Results: Thirty cases of GTN consisted of 15 choriocarcinomas, three complete moles, seven epithelioid trophoblastic tumors (ETT), and five placental site trophoblastic tumors (PSTT) were included in the study. The median age was 41.5 years (range 26-69), and the majority (56.7%) were primary tumors. PD-L1 IHC was positive in 28/29 (96.6%) of cases while nearly all cases were TMB low (15/16, 93.8%) and microsatellite stable (MSS) (17/17, 100%). TP53 mutations were the most common, occurring in 33.3% of choriocarcinoma cases. Homologous recombination repair (HRR) pathway alterations were identified in 13.3% of choriocarcinoma cases. RTK-RAS pathway was altered in 2/5 (40%) ETT cases and 1/14 (7.1%) choriocarcinoma cases (Table 1). Conclusions: Data is consistent with previously published literature demonstrating high PDL1 expression across GTN subtypes, strongly supporting a role for checkpoint blockade. Potential alternate targeted therapies for recurrent or chemoresistant GTN include Wee1, PARP, MEK inhibitors targeting TP53, HRR, and KRAS alterations.

Twin Gestation with Complete Hydatidiform Mole and Demise of Co-Existing Fetus.

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A Histopathological Profile of Gestational Trophoblastic Disease in the Madinah Region of Saudi Arabia

Gestational trophoblastic disease (GTD) is a rare and often curable group of diseases that has a large range of morphological features, sometimes making the diagnosis difficult. The objectives of this study were to evaluate the pathological frequency and histopathological profile of GTD diagnoses in the Madinah region of Saudi Arabia (KSA). The computerized record of the pathology department of the Maternity and Children's Hospital (MCH) in Madinah, KSA, was reviewed from July 2015 to June 2021. During the study period, all the pathology reports with diagnosis of GTD were included in the study for the following parameters: age, nationality, year of diagnosis, type of GTD, and total annual number of pregnancies. Simple statistical analysis was performed, utilizing the SPSS-19 software. A total of 289 cases of GTD were diagnosed during the study period. The mean age was 33.47 ± 9.3, and most of the patients (n = 106, 36.2%) were in the fourth decade [31-40 age group]. Histologically, the most common type diagnosed was Hydatidiform mole [HM] (n = 284, 98.6%), followed by three cases of trophoblastic neoplasm (1.0%) and one case of tumor-like condition called exaggerated placental site (0.3%). Complete HM (n = 53, 50%) was common in the fourth decade, whereas partial HM (n = 50, 53.8%) was common in the third decade. In the Al Madinah region of KSA, the most common type of GTD in women was HM. Most GTD cases were found in women between the ages of 31 to 40 years. The frequency of GTD, its histopathological subtypes are consistent with most of the studies on GTD; however, larger studies involving multiple centers are recommended, for confirmation of present study's findings.

Pregnancy and Childbirth in Women With Meningioma.

BackgroundTen percent of women of childbearing age have histologically confirmed meningioma. To date, little is known regarding pregnancy-related outcomes for women with meningioma.MethodsWe used a de-identified database network (TriNetX's Research Network, https://trinetx.com/) to gather information on pregnant patients with meningioma (cohort 1) versus pregnant patients without meningioma (cohort 2). The primary outcome of interest included the impact of meningioma on mortality at one year. Secondary endpoints included ectopic or molar pregnancy, cesarean section, abortion, preterm labor, depression, pre-eclampsia/eclampsia, and craniotomy. Odds ratios (OR) with 95% confidence intervals (CI) were used to measure levels of association between each cohort and the outcomes of interest.ResultsA total of 1,739 patients were identified in each cohort following propensity-score matching. Mortality was seen in 23 patients (1.32%) in cohort 1 versus 26 patients (1.41%) in cohort 2 (OR 0.88, 95% CI {0.50, 1.55}, p=0.66). Ectopic/ molar pregnancy was seen in 31 (1.78%) versus 42 (2.42%) patients in cohorts 1 and 2, respectively (OR 0.73, 95% CI {0.046,1.17}, p=0.19). Cesarean section was seen in 126 (7.25%) versus 164 (9.43%) patients, respectively (OR 0.75, 95% CI {0.59,0.97}, p=0.020). Abortion was seen in 128 (7.36%) versus 183 (10.52%) patients, respectively (OR 0.68, 95% CI {0.53,0.86}, p=0.0011). Preterm labor was seen in 75 (4.31%) versus 119 (6.84%) patients, respectively (OR 0.61, 95% CI {0.46,0.83}, p=0.0012). Depression was seen in 258 (14.84%) versus 270 (15.53%) patients, respectively (OR 0.95, 95% CI {0.79,1.14}, p=0.57). Pre-eclampsia/eclampsia was seen in 3.11% versus 5.52% patients, respectively (OR 0.55, 95% CI {0.39,0.77}, p=0.0005). Craniotomy was seen in 74 (4.26%) versus 0 (0%) patients in cohort 1 and cohort 2, respectively.ConclusionPatients with meningioma were not at higher risk for pregnancy complications, including ectopic/molar pregnancy, cesarean section, abortion, preterm labor, pre-eclampsia/eclampsia, and mortality, compared to their non-meningioma counterparts. Still, coordinated care by neurosurgical and obstetrical providers may benefit women with meningiomas who are planning for pregnancy or are currently pregnant.

Twin/Multiple Gestations With a Hydatidiform Mole: Clinicopathologic Analysis of 21 Cases With Emphasis on Molecular Genotyping and Parental Contribution.

Complete hydatidiform moles (CHMs) and partial hydatidiform moles (PHMs) are abnormal gestations characterized by vesicular chorionic villi accompanied by variable trophoblastic hyperplasia, with or without embryonic development. CHMs are purely androgenetic (only paternal [P] chromosome complements), mostly homozygous/monospermic (~85%) but occasionally heterozygous/dispermic, whereas PHMs are overwhelmingly diandric triploid (2 paternal [P] and 1 maternal [M] chromosome complements) and heterozygous/dispermic (>95%). The presence of a fetus in a molar pregnancy usually indicates a PHM rather than a CHM; however, CHMs and PHMs rarely can be associated with a viable fetus or a nonmolar abortus in twin pregnancies and rare multiple gestation molar pregnancies have been reported. A "one-oocyte-model," with diploidization of dispermic triploid zygotes, has been proposed for twin CHM with coexisting fetus, and a "two-oocyte-model" has been proposed for twin PHM with coexisting fetus. Among 2447 products of conception specimens, we identified 21 cases of twin/multiple gestations with a molar component, including 20 CHMs (17 twins, 2 triplets, 1 quintuplet) and 1 PHM (twin). P57 immunohistochemistry was performed on all; DNA genotyping of molar and nonmolar components was performed on 9 twin CHMs, 1 triplet CHM, 1 quintuplet CHM, and 1 twin PHM. All CHM components were p57-negative and those genotyped were purely androgenetic. Twin CHMs had genotypes of P1M1+P2P2 in 5, P1M1+P1P1 in 1, and P1M1+P2P3 in 1, consistent with involvement of 1 oocyte and from 1 to 3 sperm-most commonly a homozygous CHM but involving 2 sperm in the whole conception-and compatible with a "one-oocyte-model." The triplet CHM was P1M1+P1P1+P2M2 and the quintuplet CHM was P1M1+P2M2+P2M2+P3M3+P4P4, consistent with involvement of 2 sperm and at least 2 oocytes for the triplet and 4 sperm and at least 3 oocytes for the quintuplet. The twin PHM had a P1M1+P2P3M2 genotype, consistent with involvement of 2 oocytes and 3 sperm. p57 immunohistochemistry is highly reliable for diagnosis of CHMs in twin/multiple gestations. Refined diagnosis of molar twin/multiple gestations is best accomplished by correlating morphology, p57 immunohistochemistry, and molecular genotyping, with the latter clarifying zygosity/parental chromosome complement contributions to these conceptions.

Ten-Year Review of Gestational Trophoblastic Disease at Lady Reading Hospital, Peshawar.

Objective: To determine the frequency and management outcome of gestational trophoblastic disease (GTD) in Lady Reading Hospital.Methods: This was a retrospective observational study at Lady Reading Hospital, Peshawar, from January 2011 to December 2021. Hospital records of all patients with GTD were reviewed and all were included in this study except those with an incomplete record or unconfirmed histology. Treatment was analysed in terms of surgical, chemotherapy or no treatment, and outcomes were noted in terms of complete remission, disease persistence or death.Results: In 10 years 353 patients were admitted with GTD, and the frequency of the disease was 3.72 cases per 1000 pregnancies. The most frequent lesions were complete mole 65.2% (n=230) followed by invasive mole 20.4% (n=72). Mortality rate was 0.56% (n=2).Maternal blood group analysis revealed that B positive 28.3% (n=100) was more frequent. O positive blood group was found more in the malignant form of the disease at 3.96% (n=14). GTD was most prevalent in 21 to 30 years of age (41.4%, n=146). Regarding treatment, in 69.97% (n=247) of cases, suction and evacuation were performed, in 4.2% (n=15) of cases hysterectomy was performed as primary therapy, and 4.8% (17) needed hysterectomy for chemoresistance.In this study 42.49% (n=150) were given single-agent chemotherapy and 4.8% (n=17) were given multi-agent therapy. We had 21.33% (32) patients with a risk score of 7-9. In the group with a risk score of 7-9, 15.62% (n=5) patients were directly started on multi-agent therapy because of evidence of metastasis or choriocarcinoma; the remaining 84.37% (n=27) of patients who had no evidence of metastasis, no prior chemotherapy, no choriocarcinoma and International Federation of Obstetrics and Gynecology (FIGO) stage 1 were given single-agent methotrexate with folinic acid (eight days) after informed consent. In 18.75% of patients (n=6) hysterectomy was performed as the primary treatment either for haemorrhage or with age > 40, family completed, or reluctance to undergo chemotherapy. They all had a complete cure. In 3.1% (n=1) of cases, resistance to single-agent therapy was found and multi-agent treatment was started. Overall, in 96.29% of patients, complete remission was achieved with single-agent therapy in patients with risk scores of 7-9.Conclusion: The frequency of GTD was 3.4/1000 pregnancies. Complete mole was the most frequent lesion, and single-agent chemotherapy had a good outcome in low- and high-risk patients with a risk score of 7-9 (with no evidence of metastasis, prior chemotherapy, or choriocarcinoma and FIGO stage 1).

Neurocysticercosis Complicating Pregnancy.

Infection with the pork tapeworm can result in neurocysticercosis caused by infestation of central nervous system tissues by the parasite cysts. Parenchymal brain infection can cause symptoms from mass effect that include headache, seizures, confusion, and even coma. Our objective was to describe the clinical course of neurocysticercosis infections in pregnant women. This was a case series that described clinical findings and pregnancy outcomes of women diagnosed with neurocysticercosis from 1994 through 2016 at a single institution. Their medical records were reviewed, cranial computed tomography and magnetic resonance imaging scans were assessed, and the infections were classified according to the criteria of the 2018 Infectious Diseases Society of America and the American Society of Tropical Medicine and Hygiene. Overall, 37 pregnant women with neurocysticercosis were identified. Of the 37 women, 32 were symptomatic, and 16 each had severe headaches or new-onset seizures or other neurologic sequelae. Some of these women had multiple symptoms. Others were diagnosed when neuroimaging was done for a history of neurocysticercosis or evaluation of a preexisting seizure disorder. The most common treatment was with anthelmintics-albendazole, praziquantel, or both-usually given with anticonvulsants and corticosteroids to decrease inflammation. There were eight women in whom invasive neurosurgical procedures were performed, usually for hydrocephaly. Overall, 32 healthy neonates were born at term, and there was one preterm delivery at 34 weeks of gestation. The four pregnancy losses included two molar pregnancies, one anembryonic miscarriage, and a 23-week stillbirth of a pregnancy complicated by preeclampsia with severe features. Neurocysticercosis in pregnant women may be asymptomatic or result in headaches, seizures, confusion, nausea and vomiting, altered mental status, or obtundation. Anthelmintic treatment is usually successful, but in some women neurosurgical procedures are necessary to relieve obstructive hydrocephaly.

Partial Molar Pregnancy Presenting as a Tubal Ectopic Pregnancy

Background Tubal molar pregnancy is extremely rare, with no more than 200 cases reported in the literature. The incidence is approximated at 1.5 per 1,000,000 pregnancies. Case We report the case of a 22-year-old woman with an overall initial stable clinical presentation who was noted to have a ruptured ectopic pregnancy. She was surgically treated, and pathology revealed partial hydatidiform molar ectopic pregnancy. At the time of surgical intervention, the treating physicians had not considered molar ectopic pregnancy within the differential diagnosis, since this is a very rare presentation. Once the pathology was discovered, the patient was contacted to be scheduled for close follow-up and counseling to reduce progression to choriocarcinomas. Conclusion This case report highlights the importance of sending, reviewing, and following up on pathologic specimens for all patients undergoing surgical intervention for presumed ectopic pregnancy and ensuring that appropriate follow-up is in place for those patients.

Hydatidiform Mole; Histological Types and Age Distribution in Basrah

Background Hydatidiform mole (HM) is a placental pathology, which is a form of gestational trophoblastic disease (GTD). HM is classified into complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM). The incidence of molar pregnancy varies according to the geographical area. It is found to be higher in developing countries. Age is a risk factor for developing HM. In this study, we aim to determine the frequency of hydatidiform mole among cases of early trimester evacuation specimens and its relation to patient's age at Basrah maternity and paediatric hospital and Al- Mosawi private hospital. Patients and Methods This was a descriptive retrospective study for a four-year period; all cases of early trimester evacuation specimens were from January 1, 2017, to December 31, 2020. All specimens were fixed in 10% formalin and dehydrated in graduated alcohol, (5) micron thickness sections were obtained, stained with hematoxylin and eosin and examined, and cases of CHM, PHM and RPOG were analyzed. Results A total of 216 evacuation specimens were examined, and the patients age ranged from 14–50 years. Among these, 78.2% of patients were between 20 and 30 years. The percentage of RPOC was 54.2%, while that of CHM was 19.4% and that of PHM was 26.4%. The maximum cases of complete and partial mole were in the 20–30 years age group. Conclusions The frequency of HM was high compared to many other studies.

The relationship between complete hydatidiform mole and serum Vitamin D level: a prospective case-control study.

This study aimed to determine whether or not there was a relationship between complete hydatidiform mole (CHM) and serum Vitamin D level by comparing CHM patients with two control groups and to determine whether or not Vitamin D deficiency is a risk factor for CHM. This prospective study included 30 patients diagnosed with CHM (case group), 30 patients in the first trimester of a healthy pregnancy (control group), and 30 healthy non-pregnant subjects (control group). A record was made of serum 25-hydroxyvitamin D (25-OH D vitamin) levels, age, body mass index (BMI), gravida, parity, and the number of abortus. The serum 25-OH D vitamin levels were examined in each group and compared between groups. The 25-OH D vitamin level of all the patients in the study was determined as 11.16±8.64 ng/mL. No significant difference was determined between the groups in respect of 25 OH-D vitamin levels. When comparisons were made between the four subgroups according to the 25-OH-D level, no significant difference was determined between the CHM and control groups. When the patients were separated as obese and non-obese groups, no significant difference was determined between the groups. Severe deficiency, deficiency, or insufficient levels of serum Vitamin D are not thought to be risk factors for CHM patients.