ABSTRACT
@#Hydatidiform mole coexistent with a live fetus (CMCF) is a rare entity occurring in 1:20,000 to 1:100,000 pregnancies. Three mechanisms of this type are possible: (1) a singleton pregnancy consisting of partial mole with a triploid fetus, (2) a twin gestation consisting of an androgenic complete hydatidiform mole with a biparental diploid fetus, and (3) a twin gestation consisting of a biparental diploid fetus with a normal placenta and a partial hydatidiform mole (PHM) with a triploid fetus. The abnormal triploid fetus in a partial mole tends to die in the first trimester while the fetus coexisting with a complete or partial mole in the dizygotic twin pregnancy has a chance to survive. Early detection and diagnosis of a molar gestation with a viable fetus is needed to allow medical interventions, if available. Three cases of complete mole with a twin fetus (CMTF) that were diagnosed in the prenatal period by ultrasonography will be presented. This report will also discuss the indications for continuing the pregnancy, and review the literature on the recommended prenatal care, intrapartum management, and postpartum surveillance. This report aims to encourage others to document cases of CMTF in order to arrive at a consensus regarding its optimal management.
Subject(s)
Hydatidiform Mole , Pregnancy, TwinABSTRACT
@#The co-existence of a hydatidiform mole with a living fetus during the third trimester is extremely rare. The optimal management of such a case is controversial especially when medical and obstetric complications set in before term. The aim of management is towards avoidance of complications and planning the delivery at the most appropriate time to ensure good maternal and fetal outcome. We report the case of a 27-year-old Gravida 2 Para 1, who was diagnosed with a complete mole with co-existing live fetus at around 12 weeks age of gestation. She was referred to our institution at 31 weeks and 1 day age of gestation due to vaginal bleeding for which an emergency cesarean section was done. She delivered a live baby boy weighing 1.5 kg, with Apgar Score of 4,6,6. Chemoprophylaxis was administered and her serum beta human chorionic gonadotropin was monitored post-partum.
Subject(s)
Pregnancy , Female , Hydatidiform MoleABSTRACT
Hydatidiform mole is an abnormal gestation characterized by trophoblastic hyperplasia and overgrowth of placental villi. H. mole is classified as complete (CHM) and partial (PHM). The diagnosis is based on histopathology and genetic origin. In our set up, we used only histopathological diagnostic criteria. The incidence of molar pregnancy varies in different parts of the world. Objective of the present study was to determine the frequency, clinical presentation and morphological features of H. mole and compare them with those of other studies. Objectives: The aim of this populationbased retrospective study was to evaluate the trend in the incidence of molar pregnancy. The reported incidence of GTD in India is in consistent therefore we planned to do an analysis of the GTD at our institute which is a referral tertiary center of Punjab. Methods: Records of patients of GTD admitted from Dec 2016 to March 2018 were analyzed and incidence was calculated. The diagnosis of hydatidiform mole was based on the post-operative morphological and/or pathological findings. A total of 150 cases of retained products of conception received in the department of pathology were analysed. Results: Out of total 16 cases of molar pregnancy 5 were diagnosed as complete mole and 11 were diagnosed as partial mole. Out of 5 cases of complete mole, one case was of recurrent molar pregnancy. Conclusion: There is a need to look further about the association of age with molar pregnancies in future studies.
ABSTRACT
@#Introduction: Since the hallmark of gestational trophoblastic disease is trophoblastic proliferation, Ki67 is regarded as the best marker in studying hydatidiform mole.This study was conducted to evaluate the role of this proliferative marker in distinguishing among hydropic abortion, partial and complete hydatidiform mole. Materials and methods: This is a cross sectional study involving the application of Ki67 on a total of 90 histological samples of curetting materials from molar (partial and complete mole) and non molar hydropic abortion belong to Iraqi females, so three study groups were created. Immunohistochemical expression in villous cytotrophoblasts, syncytiotrophoblasts and stromal cells were recorded separately by three independent observers and the results were correlated statically. Results: The mean number of stained nuclei of villous cytotrophoblasts and stromal cells was the highest in complete mole and the lowest in non molar hydropic abortion. There is a significant statistical relationship regarding Ki67 labeling index in villous cytotrophoblasts between partial moles and hydropic abortion, complete mole and partial moles, hydropic abortion and complete mole. Regarding Ki67 labelling index in villous stromal cells, a significant statistical relationship achieved when the correlation done between partial mole and hydropic abortions, hydropic abortion and complete mole, while a non significant statistical relationship was achieved if the correlation done between partial and complete mole. All villous syncytiotrophoblasts showed negative results. Conclusion: Ki-67 labeling index in villous cytotrophblastic cells are useful in separating between partial moles and hydropic abortion, partial mole and complete mole, hydropic abortion and complete mole. While Ki-67 labeling index in villous stromal cells is only useful in separating between partial moles and hydropic abortion, hydropic abortion and complete mole.
ABSTRACT
Twin pregnancy with a complete mole and a coexisting healthy fetus is a rare condition. There is increased risk of developing severe complications and development of persistent trophoblastic disease. A 28 years old 2nd gravida, with 1 st vaginal delivery reported to the hospital at 20 weeks gestation as a case of dichorionic twin pregnancy. On routine USG, it showed a complete mole with a coexisting live fetus. The patient had features of anemia and severe preeclampsia. After explaining the risk to the patient and bystanders, they requested to terminate the pregnancy. She was induced for the same and delivered a normally appearing fetus. This was accompanied by evacuation of the mole. Diagnosis of complete mole was confirmed by histopathology. Twin pregnancy with acomplete mole and a coexisting healthy fetus is a rare condition. The decesion regarding management of this condition is difficult due to the various complications associated especially development of choriocarcinoma.
ABSTRACT
Hydatidiform moles are generally separated into two classifications. Complete hydatidiform moles are characterized by cystic swelling of all villi, often pronounced trophoblastic hyperplasia, lack of fetal parts, all 46 chromosomes of paternal origin, and a major risk for persistent trophoblastic tumor. Partial hydatidiform moles appear to be a milder version of complete moles with both normal and cystic villi, focal trophoblastic hyperplsia, a fetus or indication of previous fetal existence, 69 chromosomes with a maternal contribution, and a malignant potential less than described for complete moles. Hydatidiform mole with coexistent fetus is a very rare phenomenon, with an estimated incidence of 0.005 to 0.01 percent of all pregnancies. Due to advances in cytogenetics and ultrasonography, now permit the diagnosis of this pregnancy antenatally. However this unusual pregnancy has the risks of malignant change and severe medical complications, so it is a dilemma to decide continuation or termination of pregnancy. We experienced a case of partial hydatidiform mole with coexistent live fetus, which was diagnosed by ultrasonography at 12 gestational weeks, and confirmed normal karyotype (diploid) of the coexistent fetus. A brief reviews of related literature was done.