Management Of Hydatidiform Mole Research Articles

Partial molar pregnancy with live fetus in first trimester: what should we do next

Abstract. The incidence of a normal live fetus with a partial mole is extremely rare, and it varies between 5 per 100000 and 1 per 10000 of the pregnancies. A partial molar pregnancy is a variation of a molar pregnancy in which an embryo either develops incompletely or with multiple structural anomalies.A 27-year-old Primigravide at 13 weeks of gestation got admitted with spotting per vaginam, excessive nausea and vomiting, and her ultrasound revealed a hydropic placenta with multiple cysts with a live fetus. Regarding these findings, the patient continued her pregnancy under close observation, and advanced sonographic evaluations were done to rule out other differentials. Ultrasonography found mosaicism in the partial mole (mostly diploid, a small part is triploid). In this condition, the prognosis condition for the fetus to be born safely is still probable. Ethics committee meetings are held with the consideration of the fetus's condition, whether monitoring is carried out regularly, and terminating the pregnancy in case of fetal emergency.The optimal management of hydatidiform mole with the coexistent live fetus is currently uncertain. Antenatal consultation should include a detailed discussion of maternal and fetal risks. It is also necessary to have close follow-up and evaluation of the patient's condition during the antenatal and postnatal period. Keywords: first trimester, live fetus , management, partial molar pregnancy

The management of hydatidiform mole using prophylactic chemotherapy and hysterectomy for high-risk patients decreased the incidence of gestational trophoblastic neoplasia in Vietnam: a retrospective observational study.

ABSTRACTThe management of hydatidiform mole (HM) and the incidence of post-molar gestational trophoblastic neoplasia (GTN) in Vietnam has not been reported to date. This study aimed to study the incidence of HM and post-molar GTN and identify factors associated with post-molar GTN at a tertiary hospital in Vietnam. Five hundred and eighty-four patients who were treated for HM at Tu Du Hospital between January and December 2010 were included in this study. The mean age and gestational age at the first evacuation were 28.8 years old and 11.0 weeks, respectively. After the initial evacuation and pathological examination, 87 patients who were older than 40 or did not wish to have children underwent a hysterectomy, while the others underwent second curettage. All 472 patients who had human chorionic gonadotropin (hCG) ≥ 100,000 IU/L before treatment received one cycle of methotrexate with folinic acid as prophylactic chemotherapy. The incidence of HM was 11.1 per 1,000 deliveries; 47 patients (8.0%) developed post-molar GTN. Gestational week, hCG level at one week after the first evacuation, and pathological remnants were significantly associated with the development of post-molar GTN. The results of this study suggest that prophylactic chemotherapy and hysterectomy may be useful for high-risk HM patients to reduce post-molar GTN in settings in which the risk of post-molar GTN and loss to follow-up after HM are greater and hCG measurements and appropriate GTN treatments are unavailable. However, future studies on the long-term outcomes and side effects of prophylactic therapies on HM are required.

The management of hydatidiform mole with lung nodule: a retrospective analysis in 53 patients.

ObjectiveTo investigate the significance of lung nodule in hydatidiform mole, we retrospectively compared the clinical outcomes of those patients treated with different strategies.MethodsThe patients were divided into three groups: chemotherapy immediately once lung nodule was detected (group 1, n=17), delayed chemotherapy until human chorionic gonadotrophin (hCG) level met the diagnostic criteria for gestational trophoblastic neoplasia (GTN) (group 2, n=18), and hCG surveillance alone until hCG level was normalized spontaneously (group 3, n=18). The clinical parameters of these patients were collected and analyzed.ResultsTotally 53 (4.0%) patients were included from 1,323 cases with molar pregnancy during past 16 years. Among them, the diameters of lung nodules were 0.3–2.5 cm. Chemotherapy cycles for achieving hCG normalization and the failure rate of first-line chemotherapy in group 1 were significantly increased than that in group 2 (5 vs. 3 cycles, p=0.000, 58.8% vs. 11.1%, p=0.005). The hCG level of all 18 cases in group 3 was normalized spontaneously within 6 months. Of those, lung nodules of 9 patients disappeared spontaneously, accounting for 25% (9/36) of patients who initially selected observation. The proportion of single nodule in group 3 was significantly higher than that in group 2 (10/18 vs. 2/18, p=0.012).ConclusionOur results suggest that lung nodule alone is not an adequate indication of chemotherapy in molar pregnancy. hCG surveillance is safe for patients with lung nodule, especially with single nodule, as long as their hCG levels do not meet International Federation of Gynecology and Obstetrics diagnostic criteria for GTN.

The Controversy of Hydatidiform Mole Treatment In Women age ≥ 40 year-old

<p>Background: Hydatidiform mole or commonly known as molar pregnancy is one of the gestational trophoblastic disease (GTD) caused by an abnormal trophoblast proliferation. About 50% of gestational trophoblast neoplasm (GTN) arises from molar pregnancy. Higher risk of GTN was found in older patient, especially women age ≥40 years old. Management of hydatidiform mole is often faced come challenges, especially in developing country like Indonesia. Although, suction curettage is the most recommended treatment for the evacuation of molar pregnancy, hysterectomy is considerable for women who have completed childbirth and do not wish to preserve their fertility.<br />Case: Here we present case of 48 years old women with hydatidiform mole. Considering the age of the patient and the completion of her childbearing, we decided to do a laparotomy total abdominal hysterectomy for the evacuation of the mole instead of suction curettage. Turned out that this patient had an invasive mole, one of the types of gestational trophoblastic neoplasia.<br />Conclusion: Although suction curettage is the most frequent technique for molar evacuation, hysterectomy is a reasonable option as primary treatment to be performed in older patients and for those who do not wish to preserve their fertility. The other important points such as socio-economic status, education level, and geographical issues should be considered also on managing older patients with hydatidiform mole in developing countries</p>

Role of Surgery in the Management of Hydatidiform Mole in Elderly Patients: A Single-Center Clinical Experience.

Women older than 40 years develop gestational trophoblastic neoplasia (GTN) after a hydatidiform mole (HM) more often than do younger women. Therefore, in elderly women, primary hysterectomy has been advocated as first-line treatment. The aim of the present study was to evaluate whether hysterectomy could reduce the incidence of GTN after a diagnosis of HM. Seventy-six of 442 patients referred to our unit for an HM between 1994 and 2015 were older than 40 years old. Among these, 12 patients were treated by primary hysterectomy. We compared clinical features, serum human chorionic gonadotrophin (hCG), incidence of GTN, and further treatments in these patients and in those who underwent evacuation and serum hCG monitoring, using univariate and multivariate analyses. Patients treated by primary hysterectomy all had a diagnosis of a complete or invasive HM, had more hyperemesis than did control subjects (82% vs 37%, P = 0.008), and had an increased uterine volume (100% vs 41%, P = 0.001). Seven of them developed a subsequent GTN, whereas 5 patients achieved complete remission of disease after surgery (58% vs 30%, P = 0.094). All the patients who developed a GTN after surgery showed lower hCG levels than did control subjects (mean, 671.4 [SD, 1178.4] IU/L vs 23,919.4 [SD, 34,284.9] IU/L; P = 0.005), but there were no significant differences in the amount and type of chemotherapy needed to achieve remission. Primary hysterectomy after 40 years old in women affected by HM does not reduce the incidence of GTN and amount of chemotherapy. Although further studies are needed to confirm these results, a careful hCG monitoring should be recommended in these high-risk patients.

Diagnosis and management of hydatidiform mole and its complications: 2000years of a medical challenge.

Diagnosis and management of hydatidiform mole and its complications: 2000years of a medical challenge.

Clinical Presentation and Management of Hydatidiform Mole in a Peripheral Tertiary Hospital

This study was conducted in Faridpur Medical College Hospital, Faridpur, from January 2008 to December 2008 among fifty patients, diagnosed as a case of molar pregnancy. Incidenc of molar pregnancy was 8.27 per thousand pregnancy. Sixty percent of the patients were multiparous and eighty percent of low socio economic status . B positive blood group was prevalent (36%) in this study.Sixty percent( 60%) of the patients presented with amenorrhoea and abnormal vaginal bleeding.. Most of the patients (72%) were treated with suction evacuation and curettage. Of them hemorrhage was the most common immediate complication (80%). Complication like shock and perforation during evacuation was 14% and 4% respectively. Three patient (6%) developed Persistent Gestational Trophoblastic Disease(GTD) and one (2%) patient developed choriocarcinoma with lung metastasis and died. Thirty two (64%) patients attended for regular follow up but ten patients (20%) had attended irregularly and eight patients (16%) had dropped out .This study shows that follow up for molar pregnancy cases is not satisfactory in a district medical college hospital.Further improvement can be done by increasing awareness of the patients. DOI: http://dx.doi.org/10.3329/bjog.v25i2.13741 Bangladesh J Obstet Gynaecol, 2010; Vol. 25(2) : 59-64

Clinical utility of hyperglycosylated hCG in serum taken before hydatidiform mole evacuation to predict persistent trophoblastic disease

Human chorionic gonadotropin (hCG) is widely used in the management of hydatidiform mole and persistent trophoblastic disease (PTD). Studies on hyperglycosylated human chorionic gonadotropin (invasive trophoblast antigen, ITA) in PTD are limited. In serum samples taken before evacuation of molar pregnancies we measured the concentrations of free hCG beta-subunit (free hCGbeta), "total" hCG (hCG+hCGbeta) and ITA, and determined whether ITA, the two other hCG analytes, or the calculated ratios of hCGbeta/hCG+hCGbeta, hCGbeta/ITA and hCG+hCGbeta/ITA could predict the later development of PTD.A retrospective study based on blood specimens collected in the Dutch Central Registry for Hydatidiform Moles. The study group comprised 97 patients with hydatidiform moles who did not develop PTD after mole evacuation and 33 patients who did develop PTD.Serum samples from 130 patients with hydatidiform mole with or without PTD were assayed using specific (radio)immunoassays for free hCGbeta, total hCG, and ITA. From these analytes we also calculated the ratios hCGbeta/hCG+hCGbeta, hCGbeta/ITA, and hCG+hCGbeta/ITA. To predict the development of PTD from these analytes and parameters we performed receiver-operating characteristic (ROC) curve analysis, resulting in areas under the curve (AUCs) that represented the diagnostic accuracy which was rated in a range from excellent (AUC >0.9 or <0.1) to poor (AUC 0.4-0.6).The diagnostic accuracy of ITA was moderate (0.618) and not different from that of free hCGbeta (0.610) and hCG+hCGbeta (0.622).ITA as well as the other analytes and parameters in serum taken prior to evacuation from patients with molar pregnancies cannot be used to predict the subsequent development of persistent trophoblastic disease.

Clinical Utility of Hyperglycosylated hCG in Serum Taken before Hydatidiform Mole Evacuation to Predict Persistent Trophoblastic Disease

Human chorionic gonadotropin (hCG) is widely used in the management of hydatidiform mole and persistent trophoblastic disease (PTD). Studies on hyperglycosylated human chorionic gonadotropin (invasive trophoblast antigen, ITA) in PTD are limited. In serum samples taken before evacuation of molar pregnancies we measured the concentrations of free hCG beta-subunit (free hCGbeta), "total" hCG (hCG+hCGbeta) and ITA, and determined whether ITA, the two other hCG analytes, or the calculated ratios of hCGbeta/hCG+hCGbeta, hCGbeta/ITA and hCG+hCGbeta/ITA could predict the later development of PTD. A retrospective study based on blood specimens collected in the Dutch Central Registry for Hydatidiform Moles. The study group comprised 97 patients with hydatidiform moles who did not develop PTD after mole evacuation and 33 patients who did develop PTD. Serum samples from 130 patients with hydatidiform mole with or without PTD were assayed using specific (radio)immunoassays for free hCGbeta, total hCG, and ITA. From these analytes we also calculated the ratios hCGbeta/hCG+hCGbeta, hCGbeta/ITA, and hCG+hCGbeta/ITA. To predict the development of PTD from these analytes and parameters we performed receiver-operating characteristic (ROC) curve analysis, resulting in areas under the curve (AUCs) that represented the diagnostic accuracy which was rated in a range from excellent (AUC >0.9 or <0.1) to poor (AUC 0.4-0.6). The diagnostic accuracy of ITA was moderate (0.618) and not different from that of free hCGbeta (0.610) and hCG+hCGbeta (0.622). ITA as well as the other analytes and parameters in serum taken prior to evacuation from patients with molar pregnancies cannot be used to predict the subsequent development of persistent trophoblastic disease.

Diagnosis of hydatidiform mole and persistent trophoblastic disease: diagnostic accuracy of total human chorionic gonadotropin (hCG), free hCG α- and β-subunits, and their ratios

Human chorionic gonadotropin (hCG) is widely used in the management of hydatidiform mole and persistent trophoblastic disease (PTD). Predicting PTD after molar pregnancy might be beneficial since prophylactic chemotherapy reduces the incidence of PTD. A retrospective study based on blood specimens collected in the Dutch Registry for Hydatidiform Moles. A group of 165 patients with complete moles (of which 43 had PTD) and 39 patients with partial moles (of which 7 had PTD) were compared with 27 pregnant women with uneventful pregnancy. Serum samples from patients with hydatidiform mole with or without PTD were assayed using specific (radio) immunoassays for free alpha-subunit (hCGalpha), free beta-subunit (hCGbeta) and 'total' hCG (hCG + hCGbeta). In addition, we calculated the ratios hCGalpha/hCG + hCGbeta, hCGbeta/hCG + hCGbeta, and hCGalpha/hCGbeta. Specificity and sensitivity were calculated and paired in receiver-operating characteristic (ROC) curve analysis, resulting in areas under the curves (AUCs). hCGbeta, hCGbeta/hCG + hCGbeta and hCGalpha/hCGbeta show AUCs ranging between 0.922 and 0.999 and, therefore, are excellent diagnostic tests to distinguish complete and partial moles from normal pregnancy. To distinguish partial from complete moles the analytes hCGbeta, hCG + hCGbeta and the ratio hCGalpha/hCGbeta have AUCs between 0.7 and 0.8. Although hCGalpha, hCGbeta and hCG + hCGbeta concentrations are significantly elevated in patients who will develop PTD compared with patients with spontaneous regression after evacuation of their moles, in predicting PTD, these analytes and parameters have AUCs <0.7. Distinction between hydatidiform mole and normal pregnancy is best shown by a single blood specimen with hCGbeta, but hCGbeta/hCG + hCGbeta and hCGalpha/hCGbeta are also excellent diagnostic parameters. To predict PTD, hCGalpha, hCGbeta, hCG + hCGbeta and hCGalpha/hCGbeta are moderately accurate tests, although they are not accurate enough to justify prophylactic chemotherapy treatment for prevention of PTD.

Gestational trophoblastic disease: management of hydatidiform mole.

Gestational trophoblastic disease: management of hydatidiform mole.

5 Surgery in the management of gestational trophoblastic disease

The role of surgery in GTD has been outlined and explained in detail. The importance of accurate diagnosis, clinical assessment, patient resuscitation and support, individualization of management and patient selection has been stressed. The prognosis for patients with GTD is now a successful outcome in 70-100% of cases, depending on the risk factors present. Cerebral lesions still present a poor prognosis especially if developed while on chemotherapy. Advances have been made in the management of choriocarcinoma since the established use of chemotherapy. Surgery plays an important adjunctive role in the improved prognosis of the disease. This has been discussed in depth. Modern surgical methods, for example selective embolization of vessels supplying vascular bleeding tumours, have improved patients' prospects. The management of hydatidiform mole has been largely resolved by the introduction of suction curettage. It is the method of choice for the evacuation of the uterus in molar disease. Controversies have been discussed and a balanced assessment has been attempted to give the reader a realistic guide to patient management when presented with these problems. Important sequelae and complications of GTD have been presented and measures of prevention and management have been advanced. It is hoped that all this will further improve the management of the patient with GTD in the future.

Management of hydatidiform mole in women over 45 years old.

AbstractIn order to estimate the incidence of hydatidiform mole in older women, the records of 369 cases of hydatidiform mole including 27 patients over 45 years of age were investigated and compared with total numbers and distributions of 4964 pregnancies by maternal age during a 6‐year period (1975 – 1980) at Tokyo Medical College Hospital.The incidence of hydatidiform mole in women over 45 years of age was extremely high, in spite of the low rate of pregnancy for that age. The increase was 45‐fold in such older patients. Eighteen of 27 cases over 45 years of age developed subsequently into malignant changes. The rate of such malignant progressions as choriocarcinoma or invasive mole was 66% in women over the age of 45 as compared with around 15% in those under 44 years of age. Thus, women aged 45 years or more are subject to a 4.4‐fold increase in the risk of choriocarcinoma or invasive mole.

Termination of molar pregnancy by intramuscular administration of 15(S)-15-methyl-prostaglandin F 2α

Eleven patients entered a multicentre trial of repeated intramuscular injections of 15(S)-15-methyl-prostaglandin F2α (15-me-PGF2α) for terminating molar pregnancy. Duration of pregnancy ranged from 9 to 24 (median: 16) weeks and uterine size from 15 to 24 (median: 19) weeks. Complete (n=5) or incomplete (n=4) expulsion of molar tissue occurred in 9 patients (82%) after a median duration of 15.7 hours. In the remaining 2 patients treatment was interrupted after 8 hours at a cervical dilatation of 1 cm or more. Gastro-intestinal side effects were prominent in 64%. The use of prostaglandins in the management of hydatidiform mole is discussed.

Management of hydatidiform mole

Management of hydatidiform mole

Changing attitudes in the management of hydatidiform mole: A report on 196 patients admitted to the Philippine General Hospital from April 10, 1959, to March 27, 1963

Because complications of benign hydatidiform mole may endanger the life of the patient, methods of preventing their occurrence are presented. Such preventive methods include panhysterectomy or a prophylactic course of methotrexate.End results in the management of 196 patients with hydatidiform mole are presented. Within this group 10 eventually developed choriocarcinoma and 18 developed chorioadenoma destruens.

The Diagnosis and Management of Hydatidiform Mole

The Diagnosis and Management of Hydatidiform Mole