Mola hidatiforme coexistente con feto vivo después de las 20 semanas de gestación: reporte de dos casos / Hydatidiform mole coexisting with a live fetus greater than 20 weeks of gestation: Two cases report

Resumen Antecedentes: el embarazo molar coexistente con un feto vivo es una rareza y un reto médico porque se asocia con complicaciones maternas graves que ponen en riesgo la vida de la madre y su hijo. Casos clínicos: Caso 1: paciente con embarazo gemelar, con mola completa coexistente con feto vivo y terminación del embarazo por cesárea a las 33 semanas, nació una niña viva, de 1530 g, que sobrevivió sin complicaciones. Caso 2: paciente con mola parcial, embarazo complicado con preeclampsia severa, hipertiroidismo y placenta previa. La gestación se interrumpió por cesárea a las 24 semanas, el feto pesó 625 g y no sobrevivió a las maniobras de reanimación neonatal. Conclusiones: en las pacientes con embarazo molar coexistente con feto vivo deben valorarse las complicaciones presentes o potenciales que condicionan el riesgo de muerte materna y perinatal. La atención médica debe ser multidisciplinaria y siempre de común acuerdo con los padres.

Abstract Background: Coexistance of molar pregnancy and alive fetus is an extremely rare condition but a medical challenge when it is present. Several maternal medical complications are associated with these pregnancies including both mother and fetus life-threatening conditions. Clinical case: Two cases of molar pregnancies are presented in this paper. First was a twin pregnancy with a complete hydatidiform coexisting with a live fetus and cesarean birth at 33 weeks of gestation of a live female weighing 1,530 g. that survived without complications. Second case was an incomplete mole complicated with severe pre-eclampsia, hypertiroidism, and placenta previa; pregnancy was interrupted at 24 weeks of gestation and a fetus weighing 625 g was extracted by cesarean section, the neonate did not survive. Conclusion: In the presence of molar pregnancy coexisting with a live viable fetus, the present or potential complications that determine the risk of maternal and perinatal death, must be carefully assessed. A third-level perinatal facilities must be available for this kind of pregnancy complication.

[Correlation between the time of application of chorionic gonadotropins and biological variables in the gametes]. / Correlación entre el tiempo de aplicación de gonadotrofina coriónica y variables biológicas en el laboratorio de gametos.

The scheduled administration of human chorionic gonadotropin in the ovarian stimulation schemes used in Assisted reproduction has made possible to control the ovulatory phenomenon. In order to know the biological repercussion upon the ovule as to elapsed time from HCG and the time of capture, the protocols of Gametes Laboratory, were reviewed; there were 277 cases with this factor. The capture moment was from 32.88 to 41.06 hours from HCG administration, with an average of 36.8 +/- 1.01 hours. There was no significant statistical correlation with the total amount of captured oocytes, useful oocytes, defective oocytes (atresic, broken, degenerated) segmentation rate and embryonary quality. There was a positive, lineal, statistical correlation with the amount of post-mature oocytes (r = 0.35, p = 0.019) and negative with fertilization rate (r = -0.30, p = < 0.0001), both without a correlation among themselves. It was concluded that prolonged time between HCG exposition more than difficulting oocyte capture, negatively affects oocyte quality with a diminution in its possibility of being fertilized. It must be found the optimal window that permits easily obtaining the larger amount of oocytes with the best possibilities of originating healthy pre-embryos.

[The effect of the early administration of progesterone on egg recovery, fertilization and pregnancy in an institutional fertilization in vitro program]. / Efecto de la administración temprana de progesterona sobre la tasa de captura ovular, fertilización y embarazo en un programa institucional de fertilización in vitro.

39 patients which underwent an IVF-ET procedure at the INPer were divided in two groups. To one of them, progesterone was administered since the day of oocyte retrieval (group I), whereas the other group received progesterone 48 hours before hCG administration (group II). There were no statistical differences between the groups in the parameters analysed before the oocyte retrieval. There were statistical differences between the groups in progesterone levels in the day of oocyte retrieval in favour of group II, and in fertilization rate and transfer rate for group I. There were no valuable differences between the groups in pregnancy rate.

[Multifactorial analysis of the blood levels of LH, FSH and estradiol in relation to ovular harvesting rates, fertilization and segmentation in patients undergoing assisted reproduction (GIFT-FIVTE)]. / Análisis multifactorial de los niveles séricos de LH, FSH y Estradiol en relación a las tasas de captura ovular, fertilización y segmentación en pacientes de reproducción asistida (GIFT-FIVTE).

This study shows that there is certain tendency to asssign more value to the observation of follicular growth by ultrasound than to hormonal levels "per se". However, the appreciation of growth is only part of the phenomenon of development and ovarian maturity, for that, surveillance with hormonal monitor of ovarian response keeps with a most important role in Assisted Reproduction Clinica. The basal levels, mainly of FSH and in a less degree LH, inversely correlate with the amount of retrieved ovocytes. Estradiol values should be interpreted with a fixed point of reference, as the day of HCG administration, and a direct relation is seen between estradiol levels and captured ovocytes; however, is of highest usefulness to value the conduct of estradiol level, with the knowledge that the prognosis for good capture rates improves with ascending values and above 700 pg in the day of HCG administration.

[Impact of the maternal age variable on ovular harvesting, fertilization and segmentation in a program of assisted reproduction]. / Impacto de la variable edad materna sobre la recuperación ovular, fertilización y segmentación en un programa de reproducción asistida.

The increased maternal age was found as responsible for the ovaric biological failure, that in turn, becomes an altered hormonal response, and a reduction in the amount of susceptible ovocytes, susceptible for capture; this diminution in the amount of ovocytes, and not an intrinsic alteration in its quality is at the moment the biological translation of ovarian aging. Therefore, maternal age variable, with its ovarian and endometrial repercussion, becomes the variable with the greatest impact in Assisted Reproduction programs. The variable age is statistically independent from other variables as procedure indication, sterility type, used ovarian stimulation. The patients age should be considered as a very important prognostic factor, when proposing the methods os Assisted Reproduction, independently of the greater risk of gestation problems.

[The mouse test. Correlation between the segmentation of murine embryos and the fertilization and segmentation of human ovocytes and pre-embryos]. / La prueba de ratón. Correlación entre la segmentación de embriones murinos y la fertilización y segmentación de ovocitos y pre-embriones humanos.

The "mouse test" resulted to be an indispensable requisite in order to do, with security, although not complete, the serum selection, to use in the extracorporal phase of FIVTE. Because of the observations it is considered that it should be tried to addition the culture medium with good quality sera; which is evident with a 90% rate, or more, of segmentation in the embryonic system of mouse, of two cells.