Persistent Gestational Trophoblastic Disease Research Articles

A study on histomorphological analysis of gestational trophoblastic disease

Abstract Background: Gestational trophoblastic disease (GTD) represents a diverse group of conditions characterized by abnormal trophoblastic proliferation within the placenta. GTD includes benign and malignant lesions, ranging from complete and partial hydatidiform moles to more severe forms like invasive moles, choriocarcinoma, placental site trophoblastic tumors (PSTTs), and epithelioid trophoblastic tumors. Given that neoplastic GTD lesions respond remarkably well to chemotherapy, early and accurate histopathological diagnosis is crucial as it directly influences treatment and prognosis. Aim and Objectives: This study examined the histomorphological features of various types of GTD alongside key clinical factors such as age, parity, and gestational period. Materials and Methods: The study was conducted in the Department of Pathology over the course of10 years, from January 2014 to January 2024. All cases of GTD confirmed through histopathological examination of hematoxylin and eosin-stained slides were included in the analysis. Results: Out of 60 diagnosed cases of GTD, 34 (56.66%) were complete hydatidiform moles, 22 (36.67%) were partial hydatidiform moles, 1 (1.67%) was an invasive mole, 1 (1.67%) was choriocarcinoma, and 2 (3.33%) were PSTTs. The age of the affected patients ranged from 18 to 45 years, with the highest incidence observed in the 20–25 year age group (30 cases, 50%). Most cases (33, 55%) occurred during the first trimester, with a predominance among primigravida patients (28 cases, 46.66%). The most common clinical presentation was per vaginal bleeding, reported in 56 cases (93.33%). Conclusion: Although GTD can lead to serious complications, including metastasis, it is treatable. In this study, the complete hydatidiform mole was the most frequently encountered lesion and is associated with a higher risk of severe complications such as persistent GTD, invasive moles, and choriocarcinoma. Thus, early and accurate histopathological diagnosis is vital for the timely initiation of therapy, ultimately reducing the mortality rate. This study highlights the various categories and histomorphological features of GTD, emphasizing the importance of understanding its clinical presentation to mitigate disease burden and complications.

Role of continuing regular follow-up of serial B-human chorionic gonadotropin measurements with health education following initial surgical management of complete molar pregnancy cases

Objective: Our goal to confirm complete cure, early detection of persistent gestational trophoblastic disease and more effective and less complex treatment. Methods: Fifty-one patients from 12,960 were admitted to the Department of Obstetrics and Gynecology at Tobruk Medical Center between August 2018 and July 2021 with complete molar pregnancy, the diagnosis was confirmed with histopathology after initial surgical management. Following identification of these patients, due to lack of registration centers, the patient's telephone was required to complete the data for continuing regular follow-ups over a period of time these patients were evaluated prospectively according to their age, number of deliveries, history of normal and abnormal pregnancy, the quantity of beta-human chorionic gonadotropin (B-HCG) at the time of diagnosis and follow-up and treatment type. Persistent gestational trophoblast disease was diagnosed on the basis of a rise of B-HCG after initial evacuation, and just one patient in our study diagnosed with invasive mole and underwent second evacuation and none of these patients developed choriocarcinoma during the follow-up period. Analysis was conducted by using the social package of statistical science (SPSS) version 25 software. Results: 51 patients (0.39%) were diagnosed with complete molar pregnancy (CMP), the mean age was 31.90 (8.169) years range (17-47 years). Among 51 patients with CMP over three years, seventeen patients (33.3%) were diagnosed with persistent gestational trophoblast disease (PGTD), the incidence is about 1.3 per 1000 per deliveries, thirty-four patients (66.7%) reached spontaneous remission of molar gestation in a median time of 61 days and had a total follow-up time of 24 months. Conclusion: Follow-up women with complete molar pregnancy especially after initial management is challenging task as the incidence of molar pregnancy increasing and exposed to the risk of developing persistent gestational trophoblastic disease, and there are no specialist centres for documentation and surveillance programme. And due to wide geographical area in Libya and difficulty in the follow-up patients with molar pregnancies, especially after initial treatment has been performed. Therefore, we must create multiple centers throughout the country to cover all cases as much as possible and the communication between the patients and centers via internet, to ensure early detection of pregnancy complications.

Molar Pregnancy with a Coexistent Fetus following Assisted Reproductive Techniques: A Review of Literature of the Clinical Course and Sequelae

Abstract The clinical course and sequelae of molar pregnancy pose several diagnostic and management challenges, especially conceiving after assisted reproductive technology. A review of the literature was conducted on molar pregnancy with a coexistent fetus following assisted reproductive techniques, its clinical course, and sequelae. The literature review was conducted using search terms “coexistent fetus,” “hydatidiform mole,” “twin,” “assisted conception” AND “persistent gestational trophoblastic disease (PGTD)” OR “chemotherapy” in PubMed. A literature search identified 26 reported cases conceived following assisted conception. Management guidelines for hydatidiform mole with live fetuses are very vague and do not give specificity due to the fact that it is often associated with complications and bad obstetric outcomes. It also requires continuous monitoring and follow-up in a tertiary care center anticipating disease progression to postnatal PGTD. To assess the risk of continuation of pregnancy, multicentric studies with larger sample sizes are required to have a valid finding.

Practical guidelines of the EOTTD for pathological and genetic diagnosis of hydatidiform moles.

Hydatidiform moles are rare and thus most pathologists and geneticists have little experience with their diagnosis. It is important to promptly and correctly identify hydatidiform moles given that they are premalignant disorders associated with a risk of persistent gestational trophoblastic disease and gestational trophoblastic neoplasia. Improvement in diagnosis can be achieved with uniformization of diagnostic criteria and establishment of algorithms. To this aim, the Pathology and Genetics Working Party of the European Organisation for Treatment of Trophoblastic Diseases has developed guidelines that describe the pathological criteria and ancillary techniques that can be used in the differential diagnosis of hydatidiform moles. These guidelines are based on the best available evidence in the literature, professional experience and consensus of the experts' group involved in its development.

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.

Clinical Analysis of Molar Pregnancy

Background: Molar pregnancies represent a significant burden of disease on the spectrum of gestational trophoblastic diseases. Molar pregnancy is one of the causes of maternal morbidity and mortality among women in the reproductive age group. However the magnitude, clinical features and risk factors are not well documented in our country .This study was conducted to describe these aspects of the disease entity in one tertiary level hospital. Objective: to determine the frequency and evaluate the current clinical characteristics of patients with molar pregnancy in Bangladesh. Study design: this was a cross sectional observational study. Study place and period: Department of Obstetrics and Gynaecology in BSMMU, Dhaka. Study period from January 2015 to June 2015. Study population: Patients with molar pregnancy admitted in the department of Obstetrics and Gynaecology in BSMMU during the study period. Outcome variables: Varieties of clinical presentation, diagnosis and treatment modalities. Results: The incidence of molar pregnancy was 7.3 per thousand pregnancies in BSMMU hospital during the study period. The age of the patient ranged from 18-47 years, with maximum 65% between 21-40 years age group. Only 5% patients were above the age of 40. Majority 65% of patients were multigravida while 35% were primigravida. Maximum 85% of all were from low socio-economic group. In 40% patient's blood group was B+ve and A+ve in 25% patients. Abnormal vaginal bleeding was the commonest presenting symptoms in 60% patients. Other than that 15% patients came with vaginal bleeding and passage of vesicles, 12.5% with lower abdominal pain, 7.5% patients had no symptom except amenorrhea diagnosed incidentally and other 5% had amenorrhea with exaggerated sign symptom of pregnancy. More than two third (80%) of the patients had uterus more than the period of gestation. USG, serum ß-hCG and CBC was done in all the cases. Chest X- ray was done in 60% cases. Serum ß- hCG level was found above the level of 50000 in 80% cases. Different modalities of treatment such as suction evacuation, D&C and hysterectomy were used for the patients with molar pregnancy. Suction evacuation was the first line treatment in 87.5% patients of molar pregnancy & follow up should be done at least for 6 months. Conclusion: Molar pregnancy is the disease of women in their reproductive years. It was commonly found in young multipara women of below average income group. Most common clinical manifestation was vaginal bleeding. Diagnosis was confirmed by ultrasonography and serum ß-hCG. Patients with molar pregnancy have the risks of developing persistent gestational trophoblastic disease (GTD) and should be followed up. It is now indispensible to set up a nationwide accepted protocol for the early detection and management of patient with molar pregnancy as well as to initiate a structured follow up programme to observe the prognosis of the disease.

Uterine Artery Doppler Ultrasound parameters for predicting the occurrence of persistent gestational trophoblastic disease (PGTD) after evacuation of complete hydatidiform mole, a prospective comparative cohort study

Uterine Artery Doppler Ultrasound parameters for predicting the occurrence of persistent gestational trophoblastic disease (PGTD) after evacuation of complete hydatidiform mole, a prospective comparative cohort study

Does hysteroscopy in women with persistent gestational trophoblastic disease reduce the need for chemotherapy? A prospective, single-arm, clinical trial pilot study

BackgroundThis study aimed to describe the efficacy of hysteroscopy in the management of women with the persistent gestational trophoblastic disease (PGTD)/GTN to reduce the need for chemotherapy.Materials and methodsThis prospective, single-arm, clinical trial study was recruited in an educational referral hospital between September 2018 and September 2019. Totally, 30 participants with a history of hydatidiform mole that was managed by uterine evacuation and developed low risk persistent gestational trophoblastic disease were recruited. Hysteroscopy was performed for removal of persisted trophoblastic tissue. Serum beta-hCG titer was measured before and 7 days after the procedure.ResultsThe mean ± SD age of the participants was 31.4 ± 4.6 years. There was a significant difference (p = 0.06) between that mean ± SD of beta-hCG titer before (8168.4 ± 1758) and after (2648.8 ± 5888) hysteroscopy. Only two (6.6%) cases underwent chemotherapy due to no drop in the beta-hCG titer.ConclusionHysteroscopy may play a significant role in the management of GTN, although it requires validation in larger prospective randomized studies and longer follow-up.

Loss of p57 Expression in Conceptions Other Than Complete Hydatidiform Mole: A Case Series With Emphasis on the Etiology, Genetics, and Clinical Significance.

Combined p57 immunohistochemistry and DNA genotyping refines classification of products of conception specimens into specific types of hydatidiform moles and various nonmolar entities that can simulate them. p57 expression is highly correlated with genotyping and in practice can reliably be used to identify virtually all complete hydatidiform moles (CHM), but aberrant retained or lost p57 expression in rare CHMs and partial hydatidiform moles (PHM), as well as loss in some nonmolar abortuses, has been reported. Among a series of 2329 products of conceptions, we identified 10 cases for which loss of p57 expression was inconsistent with genotyping results (none purely androgenetic). They displayed a spectrum of generally mild abnormal villous morphology but lacked better developed features of CHMs/early CHMs, although some did suggest subtle forms of the latter. For 5 cases, genotyping (4 cases) and/or ancillary testing (1 case) determined a mechanism for the aberrant p57 results. These included 3 PHMs-2 diandric triploid and 1 triandric tetraploid-and 1 nonmolar specimen with loss of p57 expression attributable to partial or complete loss of the maternal copy of chromosome 11 and 1 nonmolar specimen with Beckwith-Wiedemann syndrome. For 5 cases, including 2 diandric triploid PHMs and 3 biparental nonmolar specimens, genotyping did not identify a mechanism, likely due to other genetic alterations which are below the resolution of or not targeted by genotyping. While overdiagnosis of a PHM as a CHM may cause less harm since appropriate follow-up with serum β-human chorionic gonadotropin levels would take place for both diagnoses, this could cause longer than necessary follow-up due to the expectation of a much greater risk of persistent gestational trophoblastic disease for CHM compared with PHM, which would be unfounded for the correct diagnosis of PHM. Overdiagnosis of a nonmolar abortus with loss of p57 expression as a CHM would lead to unnecessary follow-up and restriction on pregnancy attempts for patients with infertility. Genotyping is valuable for addressing discordance between p57 expression and morphology but cannot elucidate certain mechanisms of lost p57 expression. Future studies are warranted to determine whether chromosomal losses or gains, particularly involving imprinted genes such as p57, might play a role in modifying the risk of persistent gestational trophoblastic disease for PHMs and nonmolar conceptions that are not purely androgenetic but have some abnormal paternal imprinting of the type seen in CHMs.

Pathology of gestational trophoblastic disease (GTD)

Gestational trophoblastic disease (GTD) is subclassified into hydatidiform mole (HM), gestational trophoblastic tumours (GTT) and non-neoplastic trophoblastic lesions. HM, partial and complete, originate from villous trophoblast and are considered as preneoplastic conditions. The risk for the development of persistent GTD, mostly as invasive HM, ranges from 0.5% to 20%, which depends on the type of molar pregnancy. The risk of development of trophoblastic tumour after PHM is <0.5% and 2%-3% after CHM. GTT represent a spectrum of neoplasms that originates from the intermediate, largely extravillous, trophoblast and these include choriocarcinoma (CC), placental site trophoblastic tumour (PSTT), epithelioid trophoblastic tumour (ETT) and mixed trophoblastic tumour. Among tumour like conditions, exaggerated placental site reaction (EPSR) and placental site nodule (PSN) (s)/plaque (s) are included. The morphological appearances of HM can be mimicked by abnormal (non-molar) villous lesions, and similarly, GTT can be mimicked both by non-malignant tumour-like conditions and non-gestational tumours with trophoblastic differentiation, which add to the diagnostic dilemma of these rare conditions. GTT have a favourable prognosis and better response to specific chemotherapeutic regimens when compared with non-gestational malignant genital tract neoplasms. The correct diagnosis and classification of these rare conditions are therefore important. This article focusses on the morphological appearances, immunocytochemistry as an aid in the diagnosis and the changes in current WHO classification of GTDs (WHO 2020).

Magnitude of gestational trophoblastic disease at Hawassa university comprehensive specialized hospital, Ethiopia: A five-year retrospective analysis

Abstract Background: Gestational Trophoblastic Disease (GTD) is a spectrum of interrelated conditions but histologically distinct disease entities originating from placenta. It can be associated with significant morbidity and mortality in the absence of timely and proper intervention. Objective: The main objective of this study was to assess magnitude of gestational Trophoblastic disease and associated factors in Hawassa University Comprehensive Specialized Hospital. Methods: A five-year retrospective cross-sectional study was conducted in Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia from September 11, 2012 to September 11, 2017. The medical records of patients managed for GTD and the total number of deliveries during the study period were retrieved. There was a total of 16,957 deliveries and 194 Gestational trophoblastic cases. The data were entered with Epi data version 3.1statistical software and exported to Statistical Package for Social Sciences version 22.0 for analysis Results: The magnitude of gestational trophoblastic disease was 11.4%. Gestational trophoblastic disease was diagnosed in the first pregnancy 15.5% of cases and 40.2% between para one and four. Vaginal bleeding was the most common presenting symptom 87.1% and 46.4% patients had anemia at admission and 26.3% of patients were transfused with blood. Hydatidiform mole was the commonest disease accounting for 90.2%. Suction curettage was the commonest treatment modality 70.8%. Having history of GTD, hyperemesis gravidarum, respiratory symptoms and not referred cases had a statistically significant association with occurrence of hydatidiform mole. 7.7% of patients had remission, persistent GTD developed in 4.1% cases Conclusion: The burden of Gestational Trophoblastic Disease is persistently high in the study area. Majority of the patients were not followed as per standard after management as a result their final outcome is not known for the majority of the cases.

1279 Total Laparoscopic Hysterectomy in an 18 Week Sized Uterus with Persistent Gestational Trophoblastic Disease

Video Objective To describe and illustrate an innovative minimally invasive surgical technique to allow a total laparoscopic hysterectomy with safe and feasible extraction of an 18 week sized uterus with gestational trophoblastic neoplasia (GTN). Setting The patient is a 44 year old G4P2012 with a diagnosis of GTN, status post dilation and evacuation with increasing b-hCG levels during follow-up. Workup for metastatic disease was negative. She completed childbearing and opted for a hysterectomy as definitive treatment. Interventions Intraoperatively, the uterus appeared to be 18 weeks in size. Laparoscopic dissection started by bilateral salpingectomy and transection of the utero-ovarian ligaments, preserving the ovaries. The broad ligament was then skeletonized, and the round ligaments were transected bilaterally. The bladder flap was created, and the uterine vessels were transected bilaterally using an advanced bipolar device. A sponge on a stick soaked in methylene blue was used to delineate the cervix and vagina. The cervix was then dilated to 14’’ and evacuation was performed using 12 suction. The suction continued until all products were removed and the uterus was significantly smaller in size. The colpotomy was performed and the uterus was extracted intact. Conclusion This is the first case in the literature to describe a minimally invasive technique that demonstrates a safe and feasible laparoscopic removal of an enlarged uterus and illustrates alternative extraction techniques to avoid laparotomy in GTN. In this case, a combination of laparoscopic transection of vascular pedicles followed by a dilation and evacuation was used prior to colpotomy. The addition of dilation and evacuation allowed us to reduce the overall size of the uterus and remove it intact through the vagina with minimal bleeding, avoiding unnecessary laparotomy. This allowed the patient to have a faster post-surgical recovery, minimal blood loss (EBL 20) and no hospitalization in comparison to standard laparotomy for persistent GTN.

Twin pregnancy with complete hydatiform mole and coexisting live fetus: A rare case report

Twin pregnancy with one live fetus and one complete mole, also known as CMCF i.e. complete molar pregnancy with coexisting live fetus is a rare entity in obstetrics. This combination is associated with increased incidences of spontaneous abortions, vaginal bleeding, prematurity, intrauterine demise, pre-eclampsia, uterine ruptures, theca lutein cysts, persistent gestational trophoblastic disease. We report a rare case of a 24-year-old patient with CMCF at 14 weeks of gestation. After confirming the diagnosis, ruling out malignancy and proper counselling, decision was taken to continue her pregnancy. However, the patient had spontaneous abortion at 15 weeks of gestation. Her serum beta Hcg has shown a decreasing trend in her follow up visits with no signs suggestive of persistent gestational trophoblastic disease.

Hydatidiform Moles: Ancillary Techniques to Refine Diagnosis.

Distinction of hydatidiform moles from nonmolar specimens and subclassification of hydatidiform moles as complete hydatidiform mole versus partial hydatidiform mole are important for clinical practice and investigational studies. Risk of persistent gestational trophoblastic disease and clinical management differ for these entities. Diagnosis based on morphology is subject to interobserver variability and remains problematic, even for experienced gynecologic pathologists. To explain how ancillary techniques target the unique genetic features of hydatidiform moles to establish diagnostic truth, highlight the issue of diagnostic reproducibility and importance of diagnostic accuracy, and illustrate use of p57 immunohistochemistry and polymerase chain reaction-based DNA genotyping for diagnosis. Sources are the author's 10-year experience using ancillary techniques for the evaluation of potentially molar specimens in a large gynecologic pathology practice and the literature. The unique genetics of complete hydatidiform moles (purely androgenetic), partial hydatidiform moles (diandric triploid), and nonmolar specimens (biparental, with allelic balance) allow for certain techniques, including immunohistochemical analysis of p57 expression (a paternally imprinted, maternally expressed gene) and genotyping, to refine diagnoses of hydatidiform moles. Although p57 immunostaining alone can identify complete hydatidiform moles, which lack p57 expression because of a lack of maternal DNA, this analysis does not distinguish partial hydatidiform moles from nonmolar specimens because both express p57 because of the presence of maternal DNA. Genotyping, which compares villous and decidual DNA patterns to determine the parental source and ratios of polymorphic alleles, distinguishes purely androgenetic complete hydatidiform moles from diandric triploid partial hydatidiform moles, and both of these from biparental nonmolar specimens. An algorithmic approach to diagnosis using these techniques is advocated.

Daidzein induces choriocarcinoma cell apoptosis in a dose-dependent manner via the mitochondrial apoptotic pathway.

Choriocarcinoma is a malignant gestational trophoblastic disease and relapse or drug resistance occurs in ~25% of gestational trophoblastic tumors. Cell apoptosis serves a role in the progression from hydatidiform mole to persistent gestational trophoblastic disease. It has been demonstrated that daidzein [7‑hydroxy‑3‑(4‑hydroxyphenyl)‑4H‑chromen‑4‑one] may induce apoptosis in a number of cancer types via the mitochondrial apoptotic pathway by altering the B‑cell lymphoma (Bcl)‑2/Bcl‑2 associated X, apoptosis regulator (Bax) ratio, and activating the caspase cascade. Daidzein also serves a role in regulation of production of human chorionic gonadotropin in trophoblast cells and inhibition of cell proliferation. However, few reports have been published regarding the effect of daidzein on apoptosis in choriocarcinoma. Therefore, in the present study, JAR and JEG‑3 human gestational choriocarcinoma cells were used to investigate the effect of daidzein on apoptosis of choriocarcinoma cells. Treatment with daidzein for 48h reduced cell viability in a dose‑dependent manner. The percentages of early and late apoptotic cells also increased following treatment with daidzein in a dose‑dependent manner, with the number of late apoptotic cells increasing more prominently. Furthermore, treatment with daidzein led to apoptosis‑associated alterations in nuclear morphology of JAR and JEG-3 cells. Expression levels of cleaved poly(ADP‑ribose) polymerase, cleaved caspase‑3 and cleaved caspase‑9 increased following treatment with daidzein, whereas the Bcl‑2/Bax ratio decreased in a dose‑dependent manner. In conclusion, the results of the present study demonstrate that daidzein may induce apoptosis of choriocarcinoma cells in a dose‑dependent manner via the mitochondrial apoptotic pathway.

Complete hydatidiform mole and a coexistent viable fetus: a case report and review of the literature

A complete hydatidiform mole with a co-existing viable fetus (CMCF) is a rare clinical presentation. It is difficult to diagnose and there is no standard protocol for its management. The risks of pregnancy continuation in cases of CMCF still remain uncertain due to rarity of this situation and the possible complications (persistent gestational trophoblastic disease (GTD), preterm labour, and preeclampsia) must be assessed in relation to CMCF with mother. In such cases, it should be explained to family that a healthy fetus may be born together with/despite pregnancy related complications. Furthermore, due to GTD development risk after birth, the patient should be monitored until beta-hCG decreases to an undetectable level.

Morphological Features and Immunohistochemical Expression of p57Kip2 in Early Molar Pregnancies and Their Relations to the Progression to Persistent Trophoblastic Disease.

BackgroundAlthough the morphological features characteristic of products of conception specimens including molar pregnancies are well described, substantial histopathological similarities are observed between the different entities, especially in cases of early pregnancies. Furthermore, there are no current solid criteria that could predict cases with progression to persistent gestational trophoblastic disease. In this study, we aimed to determine the most specific histopathological and immunohistochemical features required for accurate diagnosis that can reliably predict the clinical behavior.MethodsSixty-five cases of products of conception were reviewed clinically and pathologically, and any progression to persistent gestational trophoblastic disease (GTD), if present, was noted. Pathological assessment of the archival material included re-cut sections of 5 μm in thickness, routine staining with hematoxylin and eosin and immunohistochemical staining of p57Kip2.ResultsCertain histopathological criteria were found to be significant in differentiation between complete hydatidiform mole (CHM) and partial hydatidiform mole including villous shape and outline, villous trophoblast hyperplasia, and atypia in extravillous trophoblasts. There were no significant differences in any morphological or immunohistochemical features between cases with or without subsequent development of GTD.ConclusionsHistopathological diagnosis of molar pregnancy remains problematic especially in early gestation. Their diagnosis should be stated after a constellation of specific histopathological criteria in order not to miss CHM. p57Kip2 immunohistochemistry is of great value in diagnosis of cases that had equivocal morphology by histopathological examination. However, there were no significant features to predict cases that subsequently developed persistent GTD.

A Profile of Patients with Molar Pregnancy

Aims: This study was done to determine the incidence, modes of presentation and prognosis of molar pregnancy at B. P. Koirala Institute of Health Sciences.Methods: This was a prospective study done among patients with molar pregnancy admitted at BPKIHS from January 2010 to January 2011. The study was conducted after ethical clearance from Institutional Ethical Review Board of BPKIHS. Written informed consent was taken for enrollment in the study. Baseline information like age, address, race and patient’s presenting complaints, period of gestation and serial serum beta human chorionic gonadotropin (βhCG) were collected and analyzed after entering in excel sheet.Results: Total 48 cases of molar pregnancy were diagnosed during the study period. The incidence of molar pregnancy was found to be 5.58 per 1000 deliveries. The most common mode of presentation was per vaginal bleeding i.e. in 64.58% of cases. Majority of the patients were in the age group of 20-34 years (62.5%). Mean time for normalization of βhCG after suction evacuation was 10.19 weeks.Conclusions: Molar pregnancy is a pregnancy related problem which most commonly presents with per vaginal bleeding during first and second trimester. Most of the patients are treated with suction and evacuation but some develop persistent gestational trophoblastic disease.

A Case of Persistent Gestational Trophoblastic Disease after Complete Hydatidiform Mole

Gestational trophoblastic disease is an abnormal proliferations of trophoblastic tissue during pregnancy. Persistent gestational trophoblastic t umor develops in about 20% after evacuation of complete mole. Following evacuation of hydatidiform mole, the interpretation of serial serum human chorionic gonadotropin (hCG) regression patterns is important in monitoring the course of the disease. Because it is the most reliable and sensitive method for the early detection of gestational trophoblastic disease. We describe an uncommon case of complete hydatidiform mole in a 48-year-old woman, who has presented to us with complaints of bleeding. She experienced after the evacuation of a complete mole and no decreased in hCG levels over four consecutive serum hCG measurements. The patient underwent hysterectomy due to leiomyoma. Finally, pathologic diagnosis was confirmed persistent gestational trophoblastic disease. Key words: Hydatidiform mole; Gestational trophoblastic disease

Twin Pregnancy with One Fetus and One Complete Mole - A Case Report.

Twin pregnancy consisting of one fetus and one complete mole (CMCF, complete hydatidiform mole and a coexistent fetus) is an obstetric rarity with an incidence of 1/22 000 to 1/100 000 pregnancies. Associated risks include prematurity, intrauterine death, vaginal bleeding, preeclampsia, hyperthyroidism, theca lutein cysts, uterine rupture and the development of malignant neoplasia in the form of a trophoblastic tumour (GTD, persistent gestational trophoblastic disease), which is thought to be the most common complication. We report the case of a 33-year-old patient diagnosed with CMCF in the 15th week of pregnancy. After comprehensive counselling the patient chose to proceed with her pregnancy under close observation and prophylactic fetal lung maturation. We were able to extend the pregnancy to 32 weeks gestation when heavy vaginal bleeding forced a decision to deliver by caesarean section.