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PLA journal of medical schools
Part 24, Number 6,
December 2009
, pages 360-365
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https://doi.org/10.1016/S1000-1948(10)60007-XGet rights and content
Abstract
A complete hydatidiform mole with the fetus after in vitro fertilization and embryo transfer (IVF-ET) is a rare phenomenon. The diagnosis is often not easy due to the morphological similarity to a partial mole, but it is important for treatment. We present a recent case in which STR polymorphism analysis clearly revealed a different genetic origin of the fetal and molar parts. STR polymorphisms at 15 variable-number tandem repeat loci and one sex-determining locus detected by polymerase chain reaction, indicating that umbilical cord/placenta and molar tissue are parental and androgenic, respectively. During follow-up, the patient developed persistent gestational trophoblastic tumor (GTT), which was successfully treated with chemotherapy. In this case, STR polymorphism analysis accurately diagnosed a twin pregnancy consisting of a complete hydatidiform mole and fetus.
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Diagnosis and development of a complete hydatidiform mole with a live twin fetus
Eur J Obstet Gynecol Reprod Biol
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Genetic differentiation of complete hydatidiform moles coexisting with normal fetuses by tandem deoxyribonucleic acid polymorphism analysis
Ben J Obstet Gynecol
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Pathology of gestational trophoblastic tumors
Gynecol Obstet Fertil
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Development of postmolar trophoblastic disease after partial molar pregnancy
Gynecologist Oncol
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Prenatal diagnosis by DNA polymorphism analysis of the entire mole with co-existing twins
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(2003)
More references are available in the full text version of this article.
Research article
IN RETIREMENT: The role of surgery in endometrial cancer
Canadian Journal of Obstetrics and Gynecology, svezak 35, broj 4, 2013., str. 370-3
This document has been archived because it contains outdated information. It should not be used for clinical use, but only for historical research. Visit the journal's website for the latest guidelines.
Research article
A comparison between a traditional non-guided technique and a new ultrasound-guided technique for office placement of intrauterine contraceptives
International Journal of Gynecology and Obstetrics, Volume 133, Number 3, 2016, p. 338-341 (view, other).
To investigate a new method of measuring intrauterine contraception (IUCD) in the doctor's office comparing it with the traditional unguided technique.
A prospective cohort study comparing intrauterine contraceptive use between January 1, 2013 and January 31, 2015 was conducted at the University Contraception Clinic in Alexandria, Egypt. Patients between the ages of 20 and 45 who previously had a vaginal or abdominal delivery and required placement of the device were included. Patients were randomly assigned to have devices placed using an unguided method, with vaginal ultrasound to plan and confirm device placement, or with an abdominal ultrasound-guided technique. Primary outcomes were successful IUD insertion and ideal device position 1 week after insertion. Participants, counselors, and data analysts were masked to treatment assignments.
Analyzes included 40 patients in each treatment group. Successful adaptation was achieved in 32 (80%) patients in the nonguided arm and 39 (98%) patients in the ultrasound-guided arm (P = 0.04). Ideal placement was achieved in 38 (95%) patients in the ultrasound-guided arm compared with 27 (68%) patients in the non-guided arm (P = 0.02).
Ultrasound-guided IUD insertion has shown higher success and fit accuracy compared to the traditional unguided approach.
ID ANZCTR testa: ACTRN12615000526572
(Video) Hydatidiform mole/Molar pregnancyResearch article
Midazolam fails to prevent neurological damage in children with convulsive refractory febrile status epilepticus
Kinderneurologie, volume 51, number 1, 2014, p. 78-84 (view, other).
We conducted a retrospective study to compare the outcome of intravenous midazolam infusion without electroencephalography or targeted temperature control and barbiturate coma therapy with electroencephalography and targeted temperature control for the treatment of convulsive-refractory febrile status epilepticus.
Of 49 consecutive patients with convulsive refractory febrile status epilepticus admitted to the pediatric intensive care unit of our hospital, 29 were excluded because of receiving other treatment or different underlying diseases. For example, eight patients were treated with midazolam and ten with thiamylal barbiturate coma therapy. Patients treated with midazolam were intubated only when necessary, while patients in barbiturate coma were routinely intubated. Continuous electroencephalographic monitoring was used only for the barbiturate coma group. The endpoint of anesthesia titration was clinical termination of status epilepticus in the midazolam group and suppression or burst suppression patterns on electroencephalography in the barbiturate coma group. Normothermia was maintained with blankets and neuromuscular blockade in the group receiving barbiturate coma and antipyretics in the group receiving midazolam. Prognoses were measured 1 month after baseline; children are divided into groups with worse and groups with good success.
Good results were achieved in all patients in the group receiving barbiturates and coma and in 50% of patients in the group receiving midazolam (p = 0.02, Fisher's exact test).
Although the sample size was small and our study could not determine which element of the protocol was critical for neurologic outcome, the findings suggest that clinical seizure control with midazolam without continuous EEG monitoring or specific temperature control is insufficient to prevent seizures. Neurological damage in children with seizures. fireproof. febrile epileptic status.
Research article
Clinical-pathological characterization of endometrial cancer in young women: identification of a group without classical risk factors
Gynecologic Oncology, Volume 138, Issue 1, 2015, pp. 141-146 (prikaz, ostalo).
Endometrial cancer (EC) is the most common gynecological malignancy with known risk factors including estrogen excess and hereditary syndromes. The aim of this study was to determine the percentage of young women with CE attributable to these factors and whether, as we suspected, there is a third population of young women in which no factors can be identified. We were interested in comparing clinicopathological features and outcomes between subgroups to better inform treatment recommendations.
We conducted a retrospective review of women aged 15 to 49 with a diagnosis of EC or complex atypical hyperplasia. Demographic, clinical-pathological, treatment, fertility and outcome parameters were analyzed.
Of the 719 women identified, 327 could be fully assessed. 57.5% met the "high estrogen" risk criterion. 8.25% met criteria for suspected Lynch syndrome. In 34.25% classified as "None", no classic risk factors were identified. There were no statistical differences in age, pregnancy, tumor grade, choice of treatment and response to hormone therapy. Age at menarche, stage, histology and synchronous ovarian cancer differed significantly. The prevalence of synchronous ovarian cancer was 21.0% for 'None', 23.1% for 'Lynch' and 6.6% for 'High Estrogen'. For women who tried to get pregnant, 2/27 of "High Estrogen," 0/3 of "Lynch," and 2/16 of "None" achieved a live birth.
(Video) Complications: Miscarriage, Hydatidiform Mole, Ectopic Pregnancy - Maternity Nursing @LevelUpRNThis research confirmed that there is a third population of young women with EC that does not have classic risk factors and has different clinicopathological parameters. No differences were observed in the success rate of conservative treatment or live births in the small cohort in which this method of treatment was tested.
Research article
The levonorgestrel intrauterine system: a cohort study to assess the satisfaction of the postpartum population in Kenya
Contraceptie, volume 91, number 4, 2015, p. 295-300 (display, other).
The levonorgestrel intrauterine system (LNG IUS) may become the next long-acting contraceptive to enter public sector programs in poor countries. While IUD and subcutaneous implant services are growing, little is known about how the LNG-IUS might fit in.
We conducted a cohort study of 313 women in Kenya who were 6 to 12 weeks postpartum when they started using these methods: subdermal implant (205), LNG IUS (93), and copper IUD (15). Participants returned for 6- and 12-month visits to exchange information on bleeding patterns, side effects, satisfaction, and continued use of the product. We used Kaplan-Meier techniques to estimate method continuation rates and chi-square tests of association to identify differences in method experience.
The 12-month continuation rate for the LNG IUS was 89.1 (95% confidence interval [CI] = 86.9-94.9) and was statistically equivalent to that of the subdermal implant (91.8: 95% CI = 80.6 -94.0). Almost 87% of LNG IUS users were very satisfied with the method after 6 months compared to 75% of implant users; this gap closed somewhat after 12 months as implant user satisfaction increased. After 12 months, 78% of LNG IUS users felt that their bleeding pattern was very acceptable compared to approximately 66% of implant users.
This study showed that the LNG IUS is more favorable compared to the subdermal implant in terms of satisfaction level and continued use. The LNG IUS will provide another long-acting option for postpartum women.
The LNG IUS will soon be available for purchase by international donor organizations for use in public sector programs in sub-Saharan Africa and other poor countries. The results of this study suggest that the product will be successful in future launch activities.
Research article
Hysteroscopic resection in the treatment of early-stage endometrial cancer: report of 2 cases and review of the literature
Journal of Minimally Invasive Gynecology, svezak 22, broj 1, 2015., str. 34-3
Although endometrial cancer, the most common gynecological malignancy, is most often diagnosed in postmenopausal women, it affects young women who want to preserve their fertility. The purpose of this article is to describe 2 cases of stage IA endometrial cancer treated conservatively with a combination of hysteroscopic surgery and fertility-sparing medical therapy, in one of which a successful pregnancy was achieved using assisted reproduction, and the existing literature on the use of hysteroscopic resection in the conservative treatment of endometrial cancer to preserve fertility. The addition of hysteroscopic resection to the conservative treatment of early-stage endometrial cancer may be a way to improve response and recurrence rates in women who wish to preserve their fertility and may provide other additional benefits, such as shorter time to remission and faster recovery of fertility. Key factors for the success of this approach include an interdisciplinary approach, comprehensive patient counseling, and the availability of a team experienced in hysteroscopic resection.
Supported byProduction and Research Projects of Guangdong Province(2007B090400140).
Copyright © 2009. PLA Medical Faculty Journal Editorial Board. Published by Elsevier (Singapore) Pte Ltd. All rights reserved.
FAQs
What is a complete complete hydatidiform mole? ›
Complete hydatidiform moles (CHM) are abnormal pregnancies with no fetal development resulting from having two paternal genomes with no maternal contribution. It is important to distinguish CHM from partial hydatidiform moles, and non-molar abortuses, due to the increased risk of gestational trophoblastic neoplasia.
How common are molar pregnancies after IVF? ›Around 1 in 1,000 pregnancies result in a molar pregnancy.
Can you have a molar pregnancy after IVF? ›Likewise, the risk of recurrence of molar pregnancy with IVF ranges from 1/7 at its highest to 1/27 at its lowest. We have no data for patients who suffered 2 molar pregnancies with ART. This may be as the numbers are low, as no patients suffered 2 repeat molar pregnancies.
What is a complete hydatidiform mole with a coexisting live fetus? ›Twin molar pregnancy with a hydatidiform mole and a coexisting live fetus is a rare form of gestational trophoblastic disease associated with an increased risk of obstetric complications and poor perinatal outcome. Prenatal diagnosis is essential for couple counseling and follow-up in Tertiary Reference Centers.
How do you treat a complete hydatidiform mole? ›Treatment involves surgical removal of the molar pregnancy followed by surveillance of serial human chorionic gonadotropin (hCG) levels to confirm resolution of disease or to identify development of gestational trophoblastic neoplasia (GTN), which includes invasive mole, choriocarcinoma, placental site trophoblastic ...
Is a hydatidiform mole a baby? ›As described previously, hydatiform moles arise from gestational tissue. In complete hydatidiform mole, there is no fetal tissue present; in partial hydatiform moles, there is some residual fetal tissue.
How rare is a complete molar pregnancy? ›A molar pregnancy is an abnormality of the placenta, caused by a problem when the egg and sperm join together at fertilization. Also called gestational trophoblastic disease (GTD), hydatidiform mole or simply referred to as a “mole”, this is a rare condition occurring in 1 out of every 1,000 pregnancies.
What causes a hydatidiform mole? ›Mutations in multiple genes have been found to cause recurrent hydatidiform mole. About 55 percent of cases of this condition are caused by NLRP7 gene mutations and about 5 percent of cases are caused by KHDC3L gene mutations. Mutations in other genes each account for a small percentage of cases.
How many molar pregnancies are cancerous? ›Fewer than 15% of molar pregnancies become invasive and spread outside of the uterus. Choriocarcinoma. This is a cancerous tumor formed from trophoblast cells. It can grow and spread more quickly than other GTNs.
What happens if you don't remove a molar pregnancy? ›There may be a fetus, but the fetus can't survive. The fetus usually is miscarried early in the pregnancy. A molar pregnancy can have serious complications, including a rare form of cancer. A molar pregnancy requires early treatment.
Is molar pregnancy high risk? ›
Age. All women who become pregnant have a risk of developing a molar pregnancy but the risk is very small. Researchers have found that some types of molar pregnancy are more common in certain age groups. Complete molar pregnancies are more common in mothers over the age of 45.
What happens if a molar pregnancy is not treated? ›If a molar pregnancy is not treated or does not miscarry completely it can progress and cause a range of serious conditions (known as gestational trophoblastic neoplasia), including: persistent GTD – persistent growth of the abnormal placental tissue. invasive mole – the tumour spreads into the wall of the uterus.
What is the prognosis of complete hydatidiform mole? ›Approximately 20% of women with a complete mole develop a trophoblastic malignancy. Gestational trophoblastic malignancies (ie, gestational trophoblastic neoplasia) are almost 100% curable.
Is hydatidiform mole the same as ectopic pregnancy? ›Hydatidiform moles occurs due to a placental malformation; due to genetic aberration of the villous trophoblast. This is characterized by cystic swelling and trophoblastic proliferation. Molar gestation commonly develops within the uterus but may also occur in sites of ectopic pregnancy [3].
What symptoms occurs with a hydatidiform mole? ›- Abnormal growth of the uterus, either bigger or smaller than usual.
- Severe nausea and vomiting.
- Vaginal bleeding during the first 3 months of pregnancy.
It may convert to more invasive forms of gestational trophoblastic neoplasia (GTN), endangering women's health by more severe complications. Most GTN cases originate from HM, which is associated with uterine bleeding, preeclampsia and thyroid problems.
Can hydatidiform mole cause miscarriage? ›One possible cause of first trimester miscarriage is hydatidiform molar pregnancy, which is associated with a significantly increased risk of subsequent development of persistent gestational trophoblastic disease.
How is hydatidiform mole removed? ›Treatment of Molar Pregnancy
A molar pregnancy (hydatidiform mole) or any type of gestational trophoblastic neoplasia is completely removed, usually by D and C with suction.
A hydatidiform mole contains many cysts (sacs of fluid). It is usually benign (not cancer) but it may spread to nearby tissues (invasive mole). It may also become a malignant tumor called choriocarcinoma.
Can you naturally miscarry a molar pregnancy? ›Some molar pregnancies will miscarry without intervention, but if doctors detect molar pregnancy by ultrasound, they usually recommend a D&C or medication in order to reduce the risk of further complications. Surgery can usually remove most complete and partial moles.
How long can a molar pregnancy survive? ›
In a complete molar pregnancy, the growth stops a fetus from developing. In a partial molar pregnancy, a fetus develops but it will be abnormal and cannot survive. At most, the fetus might survive for around three months.
Can you have a viable pregnancy with a molar pregnancy? ›Molar pregnancy with a coexistent live fetus is a rare and challenging condition. Common clinical presentations that should alert the clinician to this rare condition include bleeding per vaginam, anemia, hyperemesis gravidarum, hypertension, thyrotoxicosis, and uterine size disproportionate to uterine age.
What is the most common type of hydatidiform mole? ›The most common form of GTD is hydatidiform mole, also known as molar pregnancy. There are 2 types of hydatidiform moles: complete and partial. The complete hydatidiform mole is usually diploid and entirely androgenetic in origin. Most have 46,XX karyotype; a few have a 46,XY karyotype.
When do symptoms of molar pregnancy start? ›Women with a molar pregnancy are more likely to pass blood clots or have a watery brown vaginal discharge. Some women pass pieces of the molar tissue, which can look a bit like small bunches of grapes. Bleeding caused by a molar pregnancy usually begins between weeks 6 and 12 of pregnancy.
What blood type is associated with molar pregnancy? ›Some studies have linked low levels of carotene and vitamin A in a person's diet with a higher risk of molar pregnancy. Blood type. Specific blood types—A and AB—may slightly increase the risk of GTD. Family history of molar pregnancy.
Which molar pregnancy is worse? ›There are two kinds of molar pregnancy. Both have the same result, so one isn't better or worse than the other. Both kinds are usually benign — they don't cause cancer. A complete mole happens when there's only placenta tissue growing in the womb.
Can a molar pregnancy become malignant? ›A molar pregnancy contains many cysts (sacs of fluid). It is usually benign (not cancer) but it may spread to nearby tissues (invasive mole). It may also become a malignant tumor called choriocarcinoma. Molar pregnancy is the most common type of gestational trophoblastic tumor.
What is the mortality rate of hydatidiform mole? ›Background: Twin pregnancy with a partial hydatidiform mole (PHM) and a coexistent live fetus is extremely rare. The fetus usually has a normal karyotype. The surviving rate of the fetus till lung maturity is only about 25-40%.
What are the two types of hydatidiform mole? ›Two types of hydatidiform mole, complete and partial, have been described based on both morphologic and cytogenetic criteria (Table 1). Epidemiologic studies have reported wide regional variations in the incidence of molar pregnancies.
What is the difference between a molar pregnancy and a hydatidiform mole? ›Molar pregnancies are a type of gestational trophoblastic disease. Gestational trophoblastic disease (GTD) is a group of conditions that cause tumors to grow in your uterus. Molar pregnancies are also called hydatidiform moles.
What are the characteristics of complete hydatidiform mole? ›
The complete hydatidiform mole is mainly diploid and usually has two sets of paternal chromosomes. In 80.0-90.0% of cases, it results from fertilization of an empty egg with a sperm that is then reduplicated in the homozygous diploid genome. In this case, the karyotype is always 46, XX, as 46, YY is non viable.
What is the most common cause of hydatidiform mole? ›Mutations in multiple genes have been found to cause recurrent hydatidiform mole. About 55 percent of cases of this condition are caused by NLRP7 gene mutations and about 5 percent of cases are caused by KHDC3L gene mutations. Mutations in other genes each account for a small percentage of cases.
Is hydatidiform mole cancerous? ›A hydatidiform mole contains many cysts (sacs of fluid). It is usually benign (not cancer) but it may spread to nearby tissues (invasive mole). It may also become a malignant tumor called choriocarcinoma.
What is the prognosis for hydatidiform moles? ›Outlook (Prognosis)
About 15% of cases of HM can become invasive. These moles can grow deep into the uterine wall and cause bleeding or other complications. This type of mole most often responds well to medicines. In very few cases of complete HM, moles develop into a choriocarcinoma.
Symptoms of Molar Pregnancy
Women who have a molar pregnancy (hydatidiform mole) feel as if they are pregnant. But because molar pregnancies grow much faster than a fetus, the abdomen becomes larger much faster than it does in a normal pregnancy. Severe nausea and vomiting and vaginal bleeding are common.
Complications of molar pregnancy
haemorrhage. ovarian cysts. breathlessness (when it spreads to the lungs) pre-eclampsia (toxaemia of pregnancy), involving high levels of certain substances in the blood that raise blood pressure and affect the kidneys and (sometimes) liver function.
Molar pregnancy (hydatidiform moles).
They are usually slow growing and benign, although there is a chance a mole can become cancerous. A complete molar pregnancy is much more likely to become cancerous than a partial molar pregnancy.
A hydatidiform mole or molar pregnancy is very uncommon affecting around 1 in 1,200 pregnancies. It is usually found in early pregnancy. A hydatidiform mole is sometimes detected when you have an early pregnancy ultrasound.