Hydatidiform Research Articles

Proportion of hydatidiform molar gestations among patients undergoing uterine evacuation for missed abortions, associated demographics and risk factors -Experience at a single center over 18 months

Objectives: Gestational trophoblastic diseases represent a significant obstetric morbidity among women of reproductive age, with a potential to impact women’s health substantially. Molar pregnancies present as clinical aberrations in embryogenesis and placentation during the first trimester of pregnancy. Cases with missed abortions and spontaneous incomplete abortions requiring uterine evacuation, could be an opportunity to look for molar pregnancies through histopathology which otherwise could be missed. We aim to study the proportion of hydatidiform molar gestations among patients undergoing uterine evacuation in cases of missed abortion and to evaluate the demographic and risk factors associated with hydatidiform molar gestations. Material and Methods: A prospective observational, descriptive study was conducted at the Department of Obstetrics and Gynecology of a tertiary care teaching hospital over a period of 18 months. Data was collected using a pre-tested study questionnaire which included the objectives, besides the inclusion and exclusion criteria. The abortus and uterine evacuated tissue was sent for histopathologic examination by a single histopathologist. Analysis of various epidemiological characteristics and risk factors was done using the Statistical Package for the Social Sciences software version 21. Results: Out of 67 patients presenting with missed abortions or incomplete abortions during the study period, five had hydatidiform molar gestations; an incidence of 7.5%. Upon histological examination 3 (4.5%) patients had a complete mole, 2 (3%) had a partial mole while 62 (92.5%) had non-molar histopathology. Eleven (16.4%) of the study participants had a history of previous spontaneous pregnancy loss/recurrent pregnancy losses. Three among five cases detected to have molar gestations had a history of prior spontaneous abortions (60%), and the difference observed was statistically significant (P = 0.019; Odds Ratio [95% Confidence interval] 10.25 [1.459–70.257]). Hyperthyroidism and high levels of serum beta-human chorionic gonadotrophin (β-HCG) were associated with molar gestations and this was statistically significant. Conclusion: The risk of developing molar gestation is higher in patients who had previous first-trimester losses. Importantly, this should be a differential diagnosis in instances with elevated β-HCG and high thyroid hormone levels. Histopathological examination of products of conception should be considered as an essential assessment in all presentations of spontaneous abortions requiring uterine evacuation.

Heterotopic pregnancy: a case report of intrauterine hydatidiform mole with tubal pregnancy.

We herein report a rare case of simultaneous intrauterine molar pregnancy and tubal pregnancy. A woman of childbearing age who had never been pregnant underwent an ultrasound examination 70 days after the onset of menopause. She had a history of ovulation induction. The ultrasound findings suggested a partial hydatidiform mole. She was then pathologically confirmed to have a complete hydatidiform mole after uterine suction dilation and curettage. On postoperative day 4, an ultrasound examination before discharge showed an inhomogeneous mass in the left adnexal region with mild lower abdominal pain. On postoperative day 17, the blood human chorionic gonadotropin level did not drop as expected, and a follow-up examination still indicated a mass in the left adnexal region. We were unable to rule out an ectopic hydatidiform mole. Hysteroscopy with laparoscopic exploration of the left adnexal mass and salpingotomy suggested a diagnosis of intrauterine hydatidiform mole combined with left tubal pregnancy.

LOW-RISK GESTATIONAL TROPHOBLASTIC NEOPLASIA: INSIGHTS FROM A TERTIARY CARE INSTITUTE IN INDIA

Objective: To report clinical characteristics, treatment outcomes and chemotherapy-related toxicities in patients with low-risk GTN at tertiary care centre in India. Material and Methods: This retrospective observational study was conducted at the Department of Medical Oncology of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi over 2 years. The clinical and treatment information of every patient diagnosed with GTN between December 2021 and December 2023 were examined retrospectively in their medical records. Methotrexate (MTX) was administered with folinic acid (FA) rescue to low-risk GTN patients. EMA-CO, multiagent chemotherapy, was administered every two weeks to patients with low-risk GTN who were resistant to first-line chemotherapy. Results: Only 35 of the 40 patients with low-risk GTN were able to be evaluated since five of them were lost to follow-up throughout the course of treatment.The study found that the majority of patients (71.4%) experienced a molar pregnancy before developing gestational trophoblastic neoplasia (GTN), with 91.4% developing GTN within the first 4 months. Of these, 32 patients achieved complete responses (91.4%)with MTX therapy, while 3 experienced treatment failure (8.5%). Following multiagent chemotherapy, all three ofthe patients who had not responded to initial MTX therapy experienced complete remission (CR). All patients with GTN who were at low risk had 100% overall survival (OS) and cure rates. Conclusion: With a complete response (CR) rate of 91.4% and no serious side effects, the MTX regimen proved to be highly effective in treating women with low-risk GTN.

Ethnic disparities in complete and partial molar pregnancy incidence: a retrospective analysis of arab and jewish women in single medical center

BackgroundMolar pregnancies, encompassing complete and partial moles, represent a rare and enigmatic gestational disorder with potential ethnic variations in incidence. This study aimed to investigate relations of ethnicity with risks of complete and partial molar pregnancies within an Israeli population while accounting for age differences.MethodsA retrospective study was conducted of data recorded during 2007–2021 in an academic medical center in Israel. The study population comprised 167 women diagnosed with complete or partial moles, for whom data were obtained through histological examination and P57 immunostaining. Maternal age and ethnicity were extracted from electronic medical records. Incidence rates were calculated per 10,000 live births, and a nested case-control study compared demographic characteristics and molar pregnancy incidences between Arab and Jewish women. Statistical analyses included age-adjusted comparisons, relative risk calculations and multivariate logistic regression.ResultsThe overall risk of molar pregnancy was 22 per 10,000 live births (95% confidence interval [CI] 18–25). Among Arab women, the overall risk was 21 (95% CI 17–25), and for PM and CM: 14 (95% CI 11–17) and 7 (95% CI 5–10), respectively. Among Jewish women, the overall risk was 23 (95% CI 18–29), and for PM and CM: 12 (95% CI 8–17) and 11 (95% CI 7–16), respectively. Among Arab women compared to Jewish women, the proportion of all the partial moles was higher: (65.3% vs. 51.6%, p = 0.05). The incidence of partial mole was higher among Arab than Jewish women, aged 35–39 years (26 vs. 8 per 10,000, p = 0.041), and did not differ in other age groups. After adjusting for age, the relative risk of partial moles was lower among Jews than Arabs (0.7, 95% CI 0.4-1.0, p = 0.053). For Arab compared to Jewish women, the mean age at molar pregnancies was younger: 31.0 vs. 35.1 years. However, other factors did not differ significantly between Arab and Jewish women with molar pregnancies. In multivariate analysis, Jewish ethnicity was significantly associated with a higher risk of complete molar pregnancies (OR = 2.19, 95% CI 1.09–4.41, p = 0.028).ConclusionThis study highlights ethnic differences in molar pregnancy risk within the Israeli population. Jewish ethnicity was associated with a higher risk of complete molar pregnancies, while Arab women had a significantly higher risk of partial moles. These findings underscore the need to consider ethnicity when studying gestational disorders. Further research should seek to elucidate the underlying factors contributing to these differences.

Factors Contributing to Molar Pregnancy Through a Study in Jiblah University Hospital, IBB: Study from 2017 to 2022

Background: The reported prevalence rates of hydatidiform mole (HM) vary greatly across geography and time, making worldwide comparisons challenging, especially in developing countries and resource-limited settings. To date, few studies have been reported in Yemen regarding the epidemiology, management, and outcome of patients with HM. The current study sought to investigate the prevalence of HM among women who visited a large tertiary center at Jiblah University Hospital in Yemen. Method: A retrospective study was conducted between Jun 2017 and Sep 2022 at Jiblah University Hospital, Ibb, Yemen including all women with a diagnosis of HM. Complete medical histories for all HM patients were collected and analyzed. Results: A total of 160 women diagnosed with HM at Jiblah University Hospital -Ibb study from 2017 to 2022 years were included in the study. The mean gestational age on admission was 25.2 years. Sixty-two patients (38.7%) have Hb less than normal range and 94 of patients (58.8 %) have Hb normal range 12- 15g/dl and 4 patients (2.5 %) have Hb more than normal range 15g/dl. However, the percentage blood types (A+, A-, B-, B+, O+, O- and AB+) were 40.6%, 0.6%, 5%, 0.6%, 41.9 %, 7.5% and 3.8%, respectively. On the other hand, among the sample, 4 (2.5%) women were diagnosed histopathologically to have previous V.M and while 156 (97.5%) women were diagnosed histopathologically to have no previous V.M. A number of women who had previous abortion were recorded 46(28.7%) and while the women had not previous abortion was 114(41.4%). Among the women who had smoking and no smoking were recorded 2(1.3%) and 158(98.7%), respectively. Finally, unfortunately the researchers didn’t find following risk factors in the register of patients, such as (Ovulation induction, genes mutation, infertility and birth control pills), by researching the record of patients with HM or registered as having HM. However, our study found the relationship between age groups and the previous abortion about associate risk factors of molar pregnancy. There is statistically significant difference between previous abortion and age, with P-value =0.007. Conclusion: The present study showed that incident hydatidiform mole were higher in 20-29 years of maternal age, so we found that the incidence of HM in younger age patients is the most common. Also, we found that the significant positive correlation was found between age with previous abortions. Therefore, it is recommended that women should undergo health care before pregnancy and further studies are required to provide solutions to reduce the cases of HM.

Triaging and Evaluation of Products of Conception in Abortions and Post-Partum Hemorrhage.

The proper evaluation of abortion specimens and placentas from stillbirth and post-partum cases is important for adequate clinical care of post-abortion and post-partum patients. The following topics will be reviewed: (1) the importance of evaluation of both fetal and placental tissue in first trimester abortions to confirm an intrauterine pregnancy versus an ectopic pregnancy; (2) the clinical history associated with an abortion specimen or retained products of conception (POC) influences how the pathologist should triage the specimen; (3) the criteria for diagnosis of a molar pregnancy, which is critical for clinicians to know which patients need follow-up; (4) the utility of genetic studies for both diagnosis and appropriate follow-up of the patient; and (5) the pathologic evaluation of specimens from patients with post-partum hemorrhage for placenta accreta spectrum and subinvolution of maternal vessels.

Thyrotoxicosis in Partial Mola Hidatidosa

Thyrotoxicosis is a clinical condition associated with excessive thyroid hormone levels. Symptoms can range from asymptomatic to life-threatening due to thyroid storm. Thyrotoxicosis in hydatidiform moles is a rare condition but has a high mortality rate, so etiological studies are still needed for optimal management. Case Report: Patient Mrs. T, 25 years old Hindu, Balinese, 12 weeks pregnant (Gravida 1 Para 0 abortion 0), came to the obstetrics ER on September 24, 2023 with complaints of discharge from the birth canal since the morning, nausea (+), often shaking, easily tired and often sweaty. physical examination obtained blood pressure 100/60mmHg, pulse 78x/min, respiratory rate 20x/min, axillary temperature 36.80C oxygen saturation 99%. From obstetric examination, fundus uteri height ½ center, vaginal toucher vulva vagina within normal limits, portiono (-) fluxus (+), laboratory examination obtained HCG 387,392.8 mIU/m, FT4 31.05 pmol/L (N: 9-22), TSH <0.01 uIU/mL (N: 0.4-4.2) ultrasound results describe honey comb appearance and histopathology results describe partial mola. Evacuation by curettage was performed, resulting in reduced serum ?-hCG levels and reduced thyroid hormone levels. Discussion: The patient was diagnosed with partial hydatidiform mole and thyrotoxicosis. Hydatidiform moles can cause thyrotoxicosis. This condition is caused by the structure of ?- hCG which resembles TSH so that it can activate TSH receptors. After evacuation of hydatidiform moles, normal TSH and FT4 levels will be obtained. Conclusion: The female patient with thyrotoxicosis due to hydatidiform moles had the moles evacuated, resulting in normal thyroid hormone levels.

The Co-Existence of a Live Fetus in a Twin Pregnancy with Hydatidiform Mole: Cross-Sectional Study

The Co-Existence of a Live Fetus in a Twin Pregnancy with Hydatidiform Mole: Cross-Sectional Study

Thyrotoxicosis in a molar pregnancy

Thyrotoxicosis in a molar pregnancy

A Series of Cases of Molar Pregnancies and their Outcome for 1 Year in the Tertiary Care Centre, Srikakulam

A Series of Cases of Molar Pregnancies and their Outcome for 1 Year in the Tertiary Care Centre, Srikakulam

Pregnancy Among Women Receiving Chronic Dialysis in France (2006–2020)

In women receiving chronic dialysis, fertility is impaired. The objectives of this study were to estimate the incidence rate of pregnancies among women of childbearing age (15-50 years) receiving chronic dialysis from 2006 to 2020 in France, to describe the pregnancy outcomes and renal management during pregnancy. This national observational, retrospective study was based on data from the French REIN registry matched with the National Health Data System. Over the period 2006 to 2020 in France, 348 pregnancies were identified in 240 women receiving chronic dialysis. The overall incidence of pregnancy was 11.1, 95% confidence interval (CI) (9.9-12.3) cases per 1000 person-years. Hemodialysis was the predominant modality during pregnancy. Main maternal complications were preeclampsia (n= 19) and gestational diabetes (n= 11). The most obstetric complications were premature rupture of membranes (n= 14) and polyhydramnios (n= 5). These pregnancies resulted in 174 (50%) abortions (<22 weeks), including 104 elective abortions (29.9%), 44 miscarriages (12.6%), 17 therapeutic abortions (4.9%), 5 ectopic pregnancies (1.4%), and 4 hydatidiform moles (1.2%). The remaining 174 (50%) pregnancies with deliveries (≥22 weeks) resulted in 166 live births (70 full-term [42.2%], 96 preterm births [57.8%]), and 8 stillbirths. Median gestational age was 36 weeks (32-38) for 174 deliveries. There have been improvements in maternal and fetal outcomes regarding pregnancy on chronic dialysis. However, our study shows a significant proportion of elective abortions. Better fertility management of women receiving chronic dialysis is advised by contraception or by pregnancy planning and early multidisciplinary follow-up.

Recurrent Hydatiform Mole, Clinical Features and Reproductive Outcome

Recurrent Hydatiform Mole, Clinical Features and Reproductive Outcome

Plasma Free Amino Acid and Carnitine Levels in Pregnant Women with Hydatidiform Mole: A Case-Controlled Study

Background: To determine plasma free amino acid (FAA) and carnitine levels in pregnant women with hydatidiform mole (HM). Materials and Methods: Twenty-three pregnant women with HM, and 24 healthy pregnant wo-men as controls were enrolled in the study. FAA and carnitine concentrations were measured in plasma using liquid chromatography/tandem mass spectrometry (LC-MS). Results: The levels of alanine, arginine, and valine from the 14 amino acids examined were signif-icantly lower in the HM group than in the healthy group (p = 0.019, p = 0.009, and p = 0.03, respec-tively). In addition, several carnitines, C8DC, C16:1, and C18, of the 27 carnitines examined were significantly higher in the HM group than in the control group (p = 0.021, p = 0.03, and p = 0.021, respectively). Conclusions: This study demonstrated that a decrease in some plasma FAAs and an increase in some plasma carnitine levels might be effective in the pathogenesis of HM.

The prevalence of molar pregnancy among patients with incomplete miscarriage at a maternity teaching hospital

Background and objective: Gestational trophoblastic disease (GTD) involves a range of interrelated disorders that originate from the placenta; it can be benign or malignant. In the Kurdistan region of Iraq, data about GTD and its consequences is scarce. This study aims to identify the prevalence of GTD and its types among a cohort of Kurdish women. Methods: A cross-sectional study was conducted for a one-year duration from April 1, 2020, to April 1, 2021, at the Emergency Department of Maternity Teaching Hospital, Erbil City. Pregnant women in their first trimester and early second trimester (4–14 weeks of gestation) with vaginal bleeding, pregnant women with vaginal bleeding due to incomplete miscarriage, and pregnant women with a history of missed miscarriage were included in the study. A specialized questionnaire was prepared for the purpose of data collection. Results: Out of 380 incomplete miscarriage cases who were interviewed, fifty patients with gestational trophoblastic disease were included in the current study. The prevalence of GTD was 13.1%, and the majority of patients had a partial type of GTD. The current analysis indicated that there was a statistically significant association between the types of GTD, the personal history of molar pregnancy, and the age of participants. The analysis indicated that there is no statistical association between parity, blood group, and history of miscarriage and the type of GTD. Conclusion: The prevalence of GTD was remarkably high, and the partial type of GTD was the most common form present among the participants. The majority of the cases were diagnosed during the first trimester of the pregnancy. Complete GTD was more common among patients of advanced age.

Venovenous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in metastatic choriocarcinoma during systemic chemotherapy: Case report

Rationale: Gestational trophoblastic neoplasms are rare and include multiple different types of tumors such as hydatidiform moles, placental site trophoblastic tumors, and choriocarcinoma. Metastatic choriocarcinoma is well described with an excellent prognosis when treated appropriately with chemotherapy. The most common location for metastatic disease is the lungs which can unfortunately lead to severe acute respiratory distress syndrome (ARDS) in the most severe cases. Patient concerns: Metastatic cancer has historically been a contraindication for the use of extracorporeal life support (including extracorporeal membrane oxygenation or extracorporeal membrane oxygenation [ECMO]). With advancing technology and medicine, this contraindication has been called into question. Prior case reports describe the use of ECMO in complicated cases of metastatic cancer and even choriocarcinoma with lung metastasis and refractory ARDS. Diagnoses: We describe a case in which a patient with choriocarcinoma in viable pregnancy developed lung metastasis and ARDS. Interventions: The patient was managed with venovenous ECMO successfully. Outcomes: The patient was cannulated for VV-ECMO for 14 days with subsequent full pulmonary recovery. Lessons: The purpose of this work is to help providers understand the broad utility of ECMO and the need to assess candidacy for this therapy on a case by case basis, even in the setting of metastatic cancer.

Complete hydatidiform mole with a coexisting twin live fetus (CHMTF): the uncommon diagnostic enigma—simplified

Abstract Background Twin pregnancy comprising of a complete hydatidiform mole with a coexisting twin live fetus is an uncommon condition with an incidence rate of 1 in 20,000 to 1 in 100,000 pregnancies, more so in assisted reproductive technologies. The primary diagnosis is made on ultrasound and adjunct fetal MRI helps in unequivocally differentiating it from other disorder. Case presentation We present a case report of a twin pregnancy consisting of complete hydatidiform mole with a coexisting twin live fetus in a 27-year-old primigravida conception, primarily focusing on its diagnostic algorithm and related clinical aspects, adding to the paucity of existing literature. Conclusions Following the correct diagnostic algorithm with imaging studies like USG and more importantly MRI, combined with the bioclinical picture helps in reaching the accurate diagnosis.

Impending thyroid storm caused by hydatidiform mole

Introduction: Thyroid storm is a rare but life-threatening endocrine emergency. It is an acute exaggerated clinical manifestation of thyrotoxic state. We report an impending thyroid storm caused by a hydatidiform mole in a 14-year-old girl. This paper intends to describe hyperthyroidism secondary to molar pregnancy highlighting the rare but essential evaluation of hyperthyroidism. Case: A 14-year-old girl was consulted by the obstetric division to evaluate and manage hydatidiform mole with suspected hyperthyroidism. She had frequent palpitations and tremors for 1 week ago. She also complained of nausea and vomiting 1 week before admission to the hospital. We found a Burch-Wartofsky score of 25, which was categorized as an impending thyroid storm. Laboratory results showed mild anemia, low thyroid stimulating hormone (TSH) levels, high free thyroxine (T4) levels, and markedly elevated beta-human chorionic gonadotropin (beta-hCG) levels, normal Thyroid-stimulating hormone receptor antibodies (TRAb). Other laboratory parameters are mediocre. The ECG results showed sinus tachycardia. A mole tissue biopsy of the uterus confirms the morphology of the hydatidiform mole. These findings established the diagnosis of Impending Thyroid Storm caused by a hydatidiform mole. Conclusion: A hydatidiform mole can cause thyroid storm because the hormone hCG has similar structure to TSH. Doctors should always estimate the possibility of hyperthyroidism in a molar pregnancy.

A comparison of the clinical features of molar pregnancy in adolescents and adults.

To compare the age-specific clinical features of molar pregnancy and to describe the risk factors associated with this situation. This retrospective case-control study was conducted at the Department of Obstetrics and Gynecology. Tepecik Education and Research Hospital, Izmir, Turkey. The participants included both adolescents (≤ 19 years) and adults with histologically confirmed hydatidiform moles in our institution between January 2015 and January 2022. The interventions and main outcome measures of this study involved evaluating the clinical and ultrasonographic features, as well as the risk factors, associated with molar pregnancies in adolescents. This study of 137 patients with molar pregnancy found that adults had a higher incidence of partial molar pregnancy (20 patients versus seven patients) and lower beta-hCG levels than adolescents (176.890.71 mIU/ml versus 253.734.47 mIU/ml). Adolescents had a higher likelihood of hyperthyroidism (25.4% versus 9.2%). bleeding on admission (4.2% versus 1.51%),. longer hospital stays (5.44 ± 2.73 days versus 3.59 ± 3.08 days). Higher rates of uterine enlargement and postoperative bleeding (15.5% versus 1.5%). Adolescents also required more analgesia (97% versus 89.4%). Adolescents with Gestational trophoblastic diseases (GTD) may present with more severe symptoms compared to adults, which can lead to delayed diagnosis and treatment. Further research is needed to better understand the underlying mechanisms and risk factors for GTDs in this population. Increased awareness and education can help improve recognition and management of GTDs in adolescents and improve their overall health outcomes.

31. Complex Care in an Adolescent: Management of Molar Pregnancy, Malignancy, Maternal Complications, and Malformations

31. Complex Care in an Adolescent: Management of Molar Pregnancy, Malignancy, Maternal Complications, and Malformations

Twin pregnancy with one alive and co-existing complete mole

Twin pregnancy with one alive and co-existing complete mole