Trophoblastic Tissue Research Articles

HYPERTHYROIDISM SECONDARY TO GESTATIONAL TROPHOBLASTIC DISEASE : A LITERATURE REVIEW

Gestational trophoblastic disease (GTD) is a rare form of pregnancy-related cancer that is effectively treatable. GTD is accompanied by the potentially fatal complication of hyperthyroidism. We created a review consisting of five case reports. This case report was conducted on women who became pregnant when they were >35 years old. They showed consistent laboratory results, in which there was an increase in hCG levels. TSH and thyroid stimulating antibodies cannot account for the hyperthyroidism associated with GTD. The source of the thyroid stimulating agent is trophoblastic tissue. The thyrotropic effects of ?-hCG mediate GTD hyperthyroidism. Other research examined the prevalence of hyperthyroidism in women with normal pregnancy, hydatidiform mole, and choriocarcinoma who had ?-hCG serum levels below 100,000 IU/ml. Early prenatal screening may significantly reduce hyperthyroidism rates. Thyroid hormone synthesis inhibitors treat hyperthyroidism in pregnancy. Thioamides, propylthiouracil (PTU), and methimazole (MMI) are the most prevalent U.S. antithyroid medications (ATD). Plasmaphoresis may be an option for people who are resistant to therapy or need emergency surgery. GTD can cause fatal hyperthyroidism. Anti-thyroid medicines can handle most GTD hyperthyroidism. Surgery may be a possibility for patients refractory to medical treatment.

Immunohistochemical expression of BCL-2 in hydatidiform moles: a tissue microarray study.

Hydatidiform moles (HM) are members of gestational trophoblastic diseases (GTD) and, in some cases, might progress to gestational trophoblastic neoplasia (GTN). HMs are either partial (PHM) or complete (CHM). Some HMs are challenging in arriving at a precise histopathological diagnosis. This study aims to investigate the expression of BCL-2 by immunohistochemistry (IHC) in HMs as well as in normal trophoblastic tissues "products of conception (POC) and placentas" using Tissue MicroArray (TMA) technique. TMAs were constructed using the archival material of 237 HMs (95 PHM and 142 CHM) and 202 control normal trophoblastic tissues; POC and unremarkable placentas. Sections were immunohistochemically stained using antibodies against BCL-2. The staining was assessed semi-quantatively (intensity and percentage of the positive cells) in different cellular components (trophoblasts and stromal cells). BCL-2 showed cytoplasmic expression in more than 95% of trophoblasts of PHM, CHM and controls. The staining showed a significant reduction of the intensity from controls (73.7%), PHMs (76.3%) to CHM (26.9%). There was a statistically significant difference between PHM and CHM in the intensity (p-value 0.0005) and the overall scores (p-value 0.0005), but not the percentage score (p-value > 0.05). No significant difference was observed in the positivity of the villous stromal cells between the different groups. All cellular components were visible using the TMA model of two spots/case (3 mm diameter, each) in more than 90% of cases. Decreased BCL-2 expression in CHM compared to PHM and normal trophoblasts indicates increased apoptosis and uncontrolled trophoblastic proliferation. Construction of TMA in duplicates using cores of 3 mm diameter can overcome tissue heterogeneity of complex lesions.

Immunohistochemical study of MMP-2, MMP-9, EGFR and IL-8 in decidual and trophoblastic specimens of recurrent pregnancy loss cases

Background and Aim: Unexplained recurrent pregnancy loss has been a a challenging research task to experts since there is no explicit pathophysiological mechanism and therefore, the treatment remains elusive. Immunological imbalance and morphological abnormalities are under investigation. This study aims to evaluate the implication of MMP-2, MMP-9, EGFR, and IL-8 in recurrent pregnancy loss cases. Materials & Methods: The study was carried out through comparison among two groups; the unexplained miscarriage group which consisted of 22 women, and the control group consisted of 18 women, who had electively terminated their pregnancies. Both groups were in the first trimester of gestation. The specimens included the trophoblast, decidua basalis, and decidua parietalis. The study was conducted via immunohistochemical methods. Antibodies were used against MMP-2, MMP-9, EGFR, and IL-8. The results were presented at a contingency table and were statistically analyzed with the Chi-Square Test (X2). Results: There were remarkable disparities in some cases in the comparison of the two groups. MMP-9 was detected significantly high in recurrent pregnancy loss (RPL) cases, both on trophoblastic and decidual specimens (p-value < .00001), MMP-2 displayed no difference among the two groups (mild to moderate detection on trophoblast and almost negative on decidual tissues). EGFR was highly detected in trophoblastic tissue (p-value = .014). IL-8 detection was particularly different in both trophoblast and decidua parietalis of the two groups (p-value < .01). Conclusion: The study revealed both morphological and immunological dysregulations that might participate in the RPL pathogenesis.

A profile of Gestational Trophoblastic Neoplasia in a tertiary hospital in Surabaya, Indonesia

HIGHLIGHTS This study aimed to identify the characteristics of Gestational Trophoblastic Neoplasia (GTN). GTN is chemosensitive, but without appropriate therapy and follow-up, GTN will develop into complications and fatalities. ABSTRACT Objective: Gestational Trophoblastic Neoplasia (GTN) is a pregnancy-related malignancy due to abnormal proliferation of trophoblastic tissue. This study aimed to identify the characteristics of patients with GTN to help diagnose cases of GTN earlier and provide better treatment. Materials and Methods: This was a descriptive retrospective study on medical records of patients with GTN in Dr. Soetomo General Academic Hospital Surabaya, Indonesia, during the period of January 2018 to December 2020 with a total sampling technique. There were 41 patients with GTN included as study subjects. Results: Forty-one cases of GTN met the inclusion criteria out of the fifty medical records collected. The majority of patients aged 21 – 30 years old (34%) and had parity status without data (42%). Regarding the clinical profile based on prognostic factors, the predominant patients (71%) also had no data about the time interval between the end of the last pregnancy and the first time diagnosed by GTN, Those with more than 100,000 mIU/ml of beta-hCG levels were 32%, and those without metastases were 41.5%. Most patients belonged to the low-risk group (49%) and received chemotherapy (71%) with the MTX LD regimen (69%). Conclusion: GTN occurred predominantly in reproductive women that belonged to the low-risk group. Furthermore, chemotherapy is one of the chosen therapy for those patients.

Hyperthyroidism in Gestational Trophoblastic Disease: Review Article

Gestational trophoblastic disease (GTD) is a collection of illnesses connected to pregnancy that result from aberrant placental trophoblast growth. Some GTD patients experience the rare but possibly fatal consequence of hyperthyroidism, which calls for prompt diagnosis and treatment. There is very little research on hyperthyroidism in GTD. This review examines the epidemiology, pathogenesis, and treatment of this phenomenon. The pathogenesis of hyperthyroidism in GTD has received extensive research. The trophoblastic tissue of the placenta secretes an excessive amount of hCG, which is structurally related to thyroid-stimulating hormone and has increased thyrotropic activity. Worldwide, there are different rates of hyperthyroidism in GTD, with lower rates related to high prenatal screening uptake and early GTD discovery. We were unable to pinpoint any specific risk factors for hyperthyroidism in GTD. Although surgical removal of the uterus can definitively treat hyperthyroidism, serious consequences in GTD have been recorded, including thyroid storm-induced multi-organ failure, ARDS, and pulmonary hypertension. To stop the onset of hyperthyroidism and the difficulties that go along with it, early GTD identification is essential. Women receiving surgery for GTD should be aware of hyperthyroidism as a critical postoperative factor that needs to be adequately managed. Future research should examine the elements contributing to hyperthyroidism in GTD as this may help identify high-risk female patients early. Keywords: [Gestational trophoblastic disease, Molar pregnancy, Hyperthyroidism, Hydatidiform mole, Pregnancy]

Hysteroscopic management of molar pregnancy: A series of 36 cases.

Background: Hydatidiform Mole (HM) is the most common form of gestational trophoblastic disease. Dilatation and curettage is the classical treatment of this affection. Hysteroscopic resection (HsR) is an alternative for the treatment of intra-uterine pathology. Objective: To describe the feasibility of HsR for the management of HM. Result: Case series of patients who had a complete or partial HM confirmed by histological examination of the trophoblastic tissue resected by operative hysteroscopy between 2007 and 2019. After approval of our ethics committee, we evaluated 36 patients who underwent hysteroscopic resection for molar pregnancy. Histological analysis showed partial HM in 28 patients (77.8%) and complete HM in 8 (22.2%). Main surgical complications were uterine perforation in one patient and glycine resorption in 10 patients with two cases of hyponatremia corrected by standard treatment. We performed an ultrasound control 1 month after the intervention in 19 patients (52.8%) as they had slow decrease of HCG or bleeding complaints and found retained product of conception (RPOC) in six patients (16.7%). Conclusion: This first report on a small number of patients demonstrate that hysteroscopic resection is a feasible procedure for the management of molar pregnancy. Direct visualization of the procedure helps the surgeon to control the resection. Further studies are mandatory to compare this technique with D&C in term of RPOC and fertility outcomes as it remains the standard treatment.

Risk Factors Related to Gestational Trophoblastic Disease

Background: Gestational trophoblastic diseases (GTD) consist of a group of neoplastic disorders arising from placental trophoblastic tissue after normal or abnormal fertilization. The WHO classification of GTD includes hydatidiform mole, invasive mole, choriocarcinoma, placental site trophoblastic tumor, and miscellaneous and unclassified trophoblastic lesions. This study aimed to analyze the risk factors related to the gestational trophoblastic disease. Material Methods: This prospective study was conducted at the Department of Obstetrics Gynecology in Uttara Adhunik Medical College Hospital, Dhaka, Bangladesh for 1 year; from April 2020 to March 2021. A total of 100 subjects were included in this study. Informed written consent was taken from the study subjects. Data was collected using a pre-formed data sheet. Data processing and analysis were done by using SPSS version 17. The test statistics used to analyze the data were descriptive statistics, the McNemar Chi-square test, and Repeated Measure ANOVA statistics. All patients underwent necessary investigations. All information was kept confidential and used only for this study purpose. The ethical Clearance Certificate was obtained from Bangladesh Medical College. Results: The majority of the patients were more than of 38 years age (53, 53.0%). Out of these patients, 50 (50.0%) were para one, while 40 (40.0%) were para more than four, most of the patients (63, 63.9%) were illiterate and 5 (5.0%) were graduates, most of the subjects (73, 73.0%) belonged to the low socioeconomic group. The most common presenting symptom was bleeding per vagina (35, 35.0%) followed by pain in the lower abdomen (24, 24.0%), the passage of moles (16, 16.0%), hyperemesis gravidarum (14, 14.0%) and dyspnea in 11 (11.0%) subjects. Conclusion: The disease was common in extremes of ages, low para, and grand multiparous women. The hydatidiform mole was the commonest type of trophoblastic disease in these patients. The most common presenting complaint was bleeding per vagina followed by pain in the lower abdomen. The hydatidiform mole was diagnosed in 65 (65.0%) patients, the invasive mole in 28 subjects (28.0%), and choriocarcinoma in 7 (7.0%) patients. No patient had a placental site trophoblastic tumor.

Metastatic choriocarcinoma of the breast: report of a rare case and review of literature

Choriocarcinoma (CC) is a malignant tumor of trophoblastic tissue composed of cytotrophoblastic, intermediate and syncytiotrophoblast cells. Choriocarcinoma predominantly has a gestational origin. The non-gestational type is said to arise from the gonads and pluripotent germ cells. It is a rapidly invasive tumor and metastasizes widely, but it has a good response to chemotherapy once identified. Metastatic choriocarcinoma are extremely rare in the breast. Choriocarcinomatous differentiation has also been described in neoplasm arising from many organs including colon, stomach, rectum, urinary bladder and lung. In this case report, the history, physical examination, laboratory findings and pathological findings of metastatic choriocarcinoma of the breast in a 24-year-old female are described and previous literature about metastatic choriocarcinoma is reviewed.

Gestational Trophoblastic Disease In Irrua Specialist Teaching Hospital, Nigeria: A 5-year Review

Background: Gestational Trophoblastic Diseases (GTD) is a group of interrelated heterogeneous disease of trophoblastic tissue resulting from abnormal fertilization, characterized by abnormal tissue proliferation. Characteristically, prognosis positively correlates with early diagnosis and treatment.&#x0D; Objective: The objective was to determine the burden, clinical presentation, management and outcomesof GTD at Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.&#x0D; Methodology: A five-year descriptive (retrospective) study of histologically confirmed cases of st th GTD managed in ISTH between 1 July, 2016 and 30 June, 2021 was undertaken. Inclusion criteria: patient that were management at the study site, histology confirmation and availability of the case-file for review. Women managed for other gynaecological disorders or those with suspected GTD but no histologic confirmation were excluded from the study. Statistical analysis was done using SPSS version 20.0 and the results were presented in tables.&#x0D; Results: There were 21 cases of GTD and 4703 deliveries with an incidence of 4.5 per 1000 deliveries. The mean age of participants was 32.9±7.5 years. Partial mole was the commonest histologic type (47.4%), choriocarcinoma (31.6%), complete mole (10.5%), invasive mole and placenta site trophoblastic tumor-PSTT (5.3%) respectively. Abnormal vaginal bleeding was the commonest presenting symptom 89.5% (17/19); others were excessive vomiting 52.6% (10/19) and abdominal pain 36.8% (7/19 ). The treatment modalities included suction curettage (42.1%) , suction curettage and chemotherapy (36.8%), total abdominal hysterectomy and cytotoxic chemotherapy only (15.8%).Serum Beta hCG returned to normal within 4 weeks for molar pregnancy and an average of 6 months for choriocarinoma. Default rate from surveillance was 10/19 (52.6%) while two participants (10.5%) died as cases of choriocarcinoma with advanced disease from late presentation.&#x0D; Conclusion: Abnormal vaginal bleeding was the commonest presentation of GTD with high default and mortality rates. Therefore, efforts should be geared towards education and awareness to improve early presentation, surveillance and prompt treatment.

A RETROSPECTIVE STUDY ON TRENDS OF ECTOPIC PREGNANCY WITH HISTOPATHOLOGICAL EXAMINATION.

Ectopic Pregnancy refers to implantation of fetus in a site other than normal intrauterine cavity,this includes sites like fallopian tube ,ovaries, abdominal cavity. Ectopic pregnancy accounts for 2% of conrmed pregnancy. This is one of the leading causes of mortality in the rst trimester of pregnancy. Timely diagnosis is extremely crucial as delay in diagnosis can lead to mortality. Histopathological examination is required for conrmation of ectopic pregnancy by identifying trophoblastic tissue in ectopic location, since there are other conditions which can have similar presentation clinically. Materials And Methods: This is a retrospective study conducted on 2 years data collected from January 2021 to December 2022.Clinical details like age of the patient, parity, gestational age were obtained from patients from the available data and the its entry is made in MS Excel sheet. Total of 90 cases(100%) were analyzed in this study and Results: most women with ectopic pregnancy were between the age group of 20 - 25 years 48 cases (53.3%)and presented in 2nd pregnancy 39 cases(43.3%) and most common in 6th week of gestation 29 cases(31.1%) with fallopian tube as the most common site 89 cases (98.8%)and most common on right side of fallopian tube 64 cases(71.1%) with ruptured ectopic pregnancy 57 cases (63.3%)with a total of 8 cases(8.8%) showed no evidence of trophoblastic tissue. Ectopic pregnancy is most common in w Conclusion: omen between 20 to 25 years, in 2nd pregnancy and in 6th week of gestation with most common site of right sided fallopian tube. Ectopic pregnancy was conrmed on histopathological examination on 82 cases.A total of 8 cases showed no evidence of trophoblastic tissue were reported as haematosalpinx and chronic salphingitis which are clinically mimicking ectopic pregnancy.

LA MOLE HYDATIFORME INVASIVE: A PROPOS DUN CAS ET REVUE DE LA LITTERATURE

Background: Invasive mole is a subtype of gestational trophoblastic disease (GTD) that usually develops from malignant transformation of trophoblastic tissue after evacuation of the mole. Invasive mole occurs mainly in women of childbearing age, whereas it is extremely rare in postmenopausal women. Observation: This is a 42-year-old cholecystectomized G3P2 patient who was referred for suspected GTD and whose pelvic echo and abdominal-pelvic CT scan revealed a hypervascularized image filling the uterine cavity, invading the myometrium to the serosa without invasion. The patient underwent total interannexal hysterectomy and chemotherapy with satisfactory clinical and biological follow up. Conclusion: Our case highlights the difficulties of diagnosing invasive moles in the absence of a significant history of gestational trophoblastic disease. This study reviews the diagnostic methods, histological features and therapeutic recommendations.

Gestational trophoblastic disease: an update.

Gestational trophoblastic diseases (GTD) encompass a spectrum of rarepre-malignant and malignant entitiesoriginating from trophoblastic tissue. This updated review will highlight important radiological features, pathology and classification, and provide insight into the clinical management of these uncommon disorders. There is a wide geographic variation with the incidence of hydatidiform mole varying between 0.57 and 2 per 1000 pregnancies. The use of ultrasound (US)in the management of early pregnancy symptoms and complications has positively impacted the earlier detection of these diseases and resulted in diminished morbidity. Additional imaging modalities are reserved for problem solving or assessment of pulmonary manifestations of molar pregnancy. Having an awareness of their pleomorphic sonographic presentation and additional pathology that can mimic GTD is critical to avoiding pitfalls. Histologic and molecular analysis further aids in differential diagnosis. Gestational trophoblastic neoplasia (GTN) is inclusive of all malignant GTDs, and arises after 20% of molar pregnancies but can also be seen with non-molar gestations. Biochemical monitoring with human chorionic gonadotrophin is imperative for ongoing monitoring and surveillance and allows early detection of this entity. Doppler US is used for confirmation of diagnosis with magnetic resonance imaging (MRI) reserved for problem solving or assessment of myometrial invasion. This is of heightened relevance in patients undergoing surgical management. Cross sectional imaging is reserved for patients in the setting of GTN for the purposes of staging, prognostication and in the setting of recurrent disease. This may require a combination of computed tomography, MRI and positron emission tomography. Doppler US can provide insight into chemotherapeutic response/predict resistance in patients with GTN. As our understanding of these disorders evolves, there has been maturation in management options with a shift from traditional chemotherapy to innovative immunotherapy, particularly in the setting of resistant or high-risk disease.

Unsuspected placenta accreta spectrum at vaginal delivery: assessment of incidence, characteristics, and maternal morbidity

Placenta accreta spectrum refers to morbidly adherent trophoblastic tissue invading into the gravid uterus and is associated with significant maternal morbidity. Most cases of placenta accreta spectrum are suspected antenatally, and most patients undergo planned, late-preterm cesarean hysterectomy to reduce the risk of morbidity. Rarely, however, placenta accreta spectrum is incidentally diagnosed at vaginal delivery, but there is a scarcity of data regarding these events. This study aimed to examine the incidence, characteristics, and outcomes of pregnant individuals with incidentally diagnosed placenta accreta spectrum at term vaginal delivery. This was a retrospective cohort study investigating the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population was 8,694,669 term vaginal deliveries from January 2016 to December 2019. Exclusion criteria included previous uterine scar, placenta previa, and preterm delivery. Exposure was assigned by the diagnosis of placenta accreta spectrum. The main outcomes were: (1) incidence rate, (2) clinical and pregnancy characteristics, and (3) maternal morbidity related to unsuspected placenta accreta spectrum at vaginal delivery. Multivariable binary logistic regression analysis and inverse probability of treatment weighting were fitted for statistical analysis. Unsuspected placenta accreta spectrum was reported in 1 in 3797 vaginal deliveries. In a multivariable analysis, the following were associated with increased likelihood of unsuspected placenta accreta spectrum (all, P<.05): (1) patient factor with older age, (2) uterine factors such as uterine anomaly and uterine myoma, (3) pregnancy factors including early-term delivery and previous recurrent pregnancy losses, and (4) fetal factors of in utero growth restriction and demise. Of those, uterine anomaly had the greatest association with unsuspected placenta accreta spectrum (adjusted odds ratio, 6.23; 95% confidence interval, 4.20-9.26). In a propensity score-weighted model, patients in the unsuspected placenta accreta spectrum group were more likely to have hemorrhage (65.2% vs 4.1%), blood product transfusion (21.3% vs 0.6%), hysterectomy (14.9% vs <0.1%), coagulopathy (2.9% vs 0.1%), and shock (2.9% vs <0.1%) compared with those without placenta accreta spectrum. Patients in the unsuspected placenta accreta spectrum group were also more likely to receive manual removal of the placenta compared with those in the non-placenta accreta spectrum group (25.1% vs 0.6%). This study suggests that although unsuspected placenta accreta spectrum among patients undergoing term vaginal delivery is rare, it is associated with significant morbidity. The observed association between uterine anomalies and placenta accreta spectrum warrants further investigation.

Immune response in pregnancy: An evolutionary challenge against external and internal stimuli

Immune response in pregnancy: An evolutionary challenge against external and internal stimuli

Effects of the SPI/lncRNA NEAT1 Axis on Functions of Trophoblast and Decidual Cells in Patients with Recurrent Miscarriage

Recurrent miscarriage (RM) is a frustrating and complex pregnancy disorder and long noncoding RNAs (lncRNAs) modulate susceptibility to RM. This study expounded on the role of specificity protein 1 (SP1) in functions of chorionic trophoblast and decidual cells via regulating lncRNA nuclear paraspeckle assembly transcript 1 (NEAT1). Chorionic villus tissues and decidual tissues of RM patients and normal pregnant women were collected. Real-time quantitative polymerase chain reaction and Western blotting revealed that SP1 and NEAT1 were downregulated in trophoblast and decidual tissues of RM patients, and the Pearson correlation analysis detected that they were positively correlated in expression level. Chorionic trophoblast and decidual cells of RM patients were isolated and intervened by vectors over-expressing SP1 or NEAT1 siRNAs. Thereafter, the cell counting kit-8, Transwell, flow cytometry assays detected that SP1 overexpression accelerated trophoblast cell proliferation, invasion, and migration, meanwhile, enhancing decidual cell proliferation while repressed apoptosis. Next, the dual-luciferase and Chromatin immunoprecipitation assays showed that SP1 bound to the NEAT1 promoter region and further activated NEAT1 transcription. Silencing NEAT1 reversed the efforts of SP1 overexpression on the functions of trophoblast and decidual cells. Overall, SP1 activated NEAT1 transcription, accelerating trophoblast cell proliferation, invasion, and migration and mitigating decidual cell apoptosis.

Reimplantation of trophoblastic tissue on the perimetrium after laparoscopic treatment for tubal stump pregnancy: a case report

Reimplantation of trophoblastic tissue on the perimetrium after laparoscopic treatment for tubal stump pregnancy: a case report

Quantitative Analysis of Placental Mitochondrial DNA in Severe Hypertensive Pregnancies: A Cross-sectional Study

Introduction: To address the causes of maternal mortality and morbidity, reproductive health and related disabilities is a motto of World Health Organisation (WHO). Gestational hypertension constitutes as one of the main cause for maternal morbidity and mortality. Aetiology of gestational hypertension- remains a mystery. Mitochondrial dysfunction, particularly in trophoblastic cells, could play an important role in causing gestational hypertension and is postulated to be associated with oxidative stress, impaired differentiation and invasion of trophoblastic tissue. Alterations in peripheral blood mitochondrial Deoxyribonucleic Acid (DNA) copy numbers have been thought as a possible biomarker for mitochondrial dysfunction in disorders induced by oxidative stress. Aim: To estimate, evaluate and compare the mitochondrial copy numbers between placenta of severe gestational hypertensive pregnancies and normotensive pregnancies. Materials and Methods: A cross-sectional study was conducted at Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India, with 25 clinically proven cases of severe gestational hypertensive pregnancies and 25 normotensive pregnancies, for a period of one year (August 2020 to July 2021). The placenta were collected from the Department of Obstetrics, in containers within two hours of delivery and frozen in liquid nitrogen. Relative quantitative analysis of placental mitochondrial DNA (mtDNA), were done by calculating the copy number value by comparing the levels of two nuclear genes viz., BECN1 and NEB to two mitochondrial genes viz., ND1 and ND6 by using real time quantitative Polymerase Chain Reaction (PCR). Results: The placental mitochondrial DNA copy number was higher in severe gestational hypertensive patients than in normotensive pregnancies. A total of 21 (84%) cases of the severe hypertensive placenta had higher copy numbers 100-110 vs only 13 (52%) cases had copy numbers 100-105 in the normotensive group. The difference in copy number value between them was statistically significant with p-value of 0.03. Conclusion: Present study findings suggest significant alterations at the level of the mitochondria in placenta from women with gestational hypertension, which may well contribute to gestational hypertension pathophysiology. Future research should include direct measure of placental and maternal whole body mitochondrial function, and assays that elucidate the potential modifiers of this association.

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

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

Spontaneous bilateral tubal pregnancy - case report and review of diagnostic and treatment difficulties

Introduction. Spontaneous bilateral ectopic pregnancy is a rare condition easily overlooked or misdiagnosed. We present a case of spontaneous bilateral tubal ectopic pregnancy and discuss the difficulties in diagnosing and treating such patients. Case outline. A 39-years-old patient with a history of irregular and abundant menstrual cycles complained of pelvic pain and light bleeding after 55 days of amenorrhea. Ultrasound revealed enlarged uterus with a myoma and a heterogenic formation with echogenic ring sign beside the left ovary. Free fluid with clots was present in the pelvis. As the patient was hemodynamically unstable and ectopic pregnancy was suspected, emergency laparotomy was performed. During the surgery we found that both tubes were significantly edematous, dilated, and livid in their ampullary regions. On the left tube anterior wall rupture 15 ? 8 mm was noticeable, while right tube was intact with bleeding from its abdominal ostium. Even though the patient was not informed about the possibility of bilateral salpingectomy, after thorough consideration and due to the extent of tubal damage bilateral salpingectomy was eventually performed. Histopathological analysis confirmed the presence of decidua, partially viable and partially necrotic chorionic villi, and trophoblastic tissue in both right and left tubes. Conclusions. Careful preoperative and intraoperative examination of both Fallopian tubes as well as the whole abdominal and pelvic cavity should be mandatory during every assessment of patients with ectopic pregnancy.

Renal effects of hydatiform mole and choriocarcinoma

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