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Sileo FG, Giuliani GA, Facchinetti F, Contu G, Chiossi G, Bertucci E. Complete hydatidiform mole in higher-order multiple pregnancies. Minerva Obstet Gynecol 2022; 74:308-313. [PMID: 35642715 DOI: 10.23736/s2724-606x.21.05031-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Molar degeneration of the trophoblast is a rare, yet possible, complication of pregnancies. Complete hydatidiform mole is the most common histological type among all trophoblastic tumors and it is the result of the fertilization of an empty oocyte from two sperms or by one sperm that then duplicates. Complete mole is characterized by hydropic degeneration of abnormal chorionic villi, diffused trophoblast hyperplasia and the absence of identifiable embryonic or fetal tissue; the hyperplastic trophoblast justifies the common finding of high serum beta HCG levels. Twin molar pregnancy is an uncommon obstetric event, and even less frequent are triplet/quadruplet molar pregnancies. We hereby report a case of a complete hydatidiform mole with two coexistent fetuses in a triplet pregnancy after in vitro fertilization procedure; the pregnancy ended with a therapeutic abortion. During the follow-up, the serum beta human chorionic gonadotropin concentration started to rise, and the diagnosis of post-molar gestational trophoblastic neoplasia was made and consequently methotrexate treatment was started. Due to the rarity of this condition, there are no specific guidelines for the management of multiple pregnancies complicated by complete hydatidiform mole. We therefore performed a review of the literature including all reported cases of triplets/quadruplets pregnancies complicated by complete mole of a fetus focusing on ultrasound diagnosis, treatment and outcomes of this rare and life-threatening condition.
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Affiliation(s)
- Filomena G Sileo
- Prenatal Medicine Unit, Service of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia A Giuliani
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Giannina Contu
- Prenatal Medicine Unit, Service of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Chiossi
- Prenatal Medicine Unit, Service of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Emma Bertucci
- Prenatal Medicine Unit, Service of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy -
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Irani RA, Holliman K, Debbink M, Day L, Mehlhaff K, Gill L, Heuser C, Kachikis A, Strickland K, Tureson J, Shank J, Pilliod R, Iyer C, Han CS. Complete Molar Pregnancies with a Coexisting Fetus: Pregnancy Outcomes and Review of Literature. AJP Rep 2022; 12:e96-e107. [PMID: 35178283 PMCID: PMC8843380 DOI: 10.1055/a-1678-3563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/08/2021] [Indexed: 10/26/2022] Open
Abstract
Objective The objective of the study was to review the obstetric outcomes of complete hydatidiform molar pregnancies with a coexisting fetus (CHMCF), a rare clinical entity that is not well described. Materials and Methods We performed a retrospective case series with pathology-confirmed HMCF. The cases were collected via solicitation through a private maternal-fetal medicine physician group on social media. Each contributing institution from across the United States ( n = 9) obtained written informed consent from the patients directly, obtained institutional data transfer agreements as required, and transmitted the data using a Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant modality. Data collected included maternal, fetal/genetic, placental, and delivery characteristics. For descriptive analysis, continuous variables were reported as median with standard deviation and range. Results Nine institutions contributed to the 14 cases collected. Nine (64%) cases of CHMCF were a product of assisted reproductive technology and one case was trizygotic. The median gestational age at diagnosis was 12 weeks and 2 days (9 weeks-19 weeks and 4 days), and over half were diagnosed in the first trimester. The median human chorionic gonadotropin (hCG) at diagnosis was 355,494 mIU/mL (49,770-700,486 mIU/mL). Placental mass size universally enlarged over the surveillance period. When invasive testing was performed, insufficient sample or no growth was noted in 40% of the sampled cases. Antenatal complications occurred in all delivered patients, with postpartum hemorrhage (71%) and hypertensive disorders of pregnancy (29%) being the most frequent outcomes. Delivery outcomes were variable. Four patients developed gestational trophoblastic neoplasia. Conclusion This series is the largest report of obstetric outcomes for CHMCF to date and highlights the need to counsel patients about the severe maternal and fetal complications in continuing pregnancies, including progression to gestational trophoblastic neoplastic disease. Key Points CHMCF is a rare obstetric complication and may be associated with the use of assisted reproductive technology.Universally, patients with CHMCF who elected to manage expectantly developed antenatal complications.The risk of developing gestational trophoblastic neoplasia after CHMCF is high, and termination of the pregnancy did not decrease this risk.
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Affiliation(s)
- Roxanna A Irani
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal Fetal Medicine, University of California San Francisco, San Francisco, California
| | | | - Michelle Debbink
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Utah, Salt Lake City, Utah
| | - Lori Day
- Obstetrix Medical Group, Beacon Memorial Hospital, Division of Maternal Fetal Medicine, South Bend, Indiana
| | - Krista Mehlhaff
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Lisa Gill
- Department of Obstetrics, Gynecology, and Women's Health, Division of Maternal Fetal Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Cara Heuser
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Intermountain Healthcare and University of Utah, Salt Lake City, Utah
| | - Alisa Kachikis
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Washington, Seattle, Washington
| | | | - Justin Tureson
- Department of Obstetrics and Gynecology, Naval Readiness and Training Command, Twentynine Palms, Twentynine Palms, California
| | - Jessica Shank
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Rachel Pilliod
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Division of Maternal Fetal Medicine, Portland, Oregon
| | - Chitra Iyer
- Obstetrix Medical Group of Texas, Fort Worth, Texas
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Ko PC, Peng HH, Soong YK, Chang SD. Triplet Pregnancy Complicated with One Hydatidiform Mole and Preeclampsia in a 46, XY Female with Gonadal Dysgenesis. Taiwan J Obstet Gynecol 2007; 46:276-80. [DOI: 10.1016/s1028-4559(08)60034-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Petignat P, Vassilakos P, Campana A. Are fertility drugs a risk factor for persistent trophoblastic tumour? Hum Reprod 2002; 17:1610-5. [PMID: 12042286 DOI: 10.1093/humrep/17.6.1610] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The introduction of ovulation-inducing drugs has raised concern that women exposed to these therapies may be at increased risk of cancer. We assessed the potential association between exposure to fertility drugs and the risk of developing persistent trophoblastic tumour (PTT). METHODS We conducted a systematic review of the English and non-English language literature using the National Library of Medicine's Medline to identify all observations of patients with hydatidiform mole (HM) after treatment with ovulation-inducers. RESULTS Fifty-two cases were considered including 26 singleton molar pregnancies and 26 multiple molar pregnancies consisting of an HM and one or more co-existent fetus(es) (HM-and-CF). PTT occurred in 15% of patients with singleton HM and in 42% of patients with HM-and-CF, 15% of whom had a metastatic disease. Of those patients with HM-and-CF, 16 patients delivered at <24 weeks gestation, mostly because of vaginal haemorrhage. Ten patients delivered at > or = 24 weeks of gestation, six of whom (25%) had a normal live child. These results are similar to spontaneously conceived pregnancies. CONCLUSIONS Although women having an HM after therapy with ovulation-inducing drugs seem to have no added risk of PTT, multiple pregnancies are more likely to occur, and the overall risk may be increased.
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Affiliation(s)
- Patrick Petignat
- Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
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Rajesh U, Cohn MR, Foskett MA, Fisher RA, el Zaki D. Triplet pregnancy with a coexisting complete hydatidiform mole of monospermic origin in a spontaneous conception. BJOG 2000; 107:1439-42. [PMID: 11117777 DOI: 10.1111/j.1471-0528.2000.tb11663.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- U Rajesh
- Department of Obstetrics and Gynaecology, Hereford County Hospital, UK
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Amr MF, Fisher RA, Foskett MA, Paradinas FJ. Triplet pregnancy with hydatidiform mole. Int J Gynecol Cancer 2000; 10:76-81. [PMID: 11240655 DOI: 10.1046/j.1525-1438.2000.99064.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Multiple pregnancies with hydatidiform mole are rare. We describe here a patient who delivered a male fetus and a female fetus together with molar tissue following treatment for infertility. comparing microsatellite polymorphisms in the DNA from the patient, her partner, the two normal placentas and the molar tissue, we were able to show that this was a triplet pregnancy with two normal conceptions and a complete hydatidiform mole of monospermic origin.
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Affiliation(s)
- M. F. Amr
- Departments of Obstetrics and Gynaecology, Jordan University Hospital, Amman, Jordan;Cancer Medicine, and Histopathology, Imperial College School of Medicine, Charing Cross Hospital, London, England, United Kingdom
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Chao AS, Tsai TC, Soong YK. Clinical management of a quadruplet pregnancy combining a triplet pregnancy with a classical hydatidiform mole: case report and review of literature. Prenat Diagn 1999; 19:1073-6. [PMID: 10589065 DOI: 10.1002/(sici)1097-0223(199911)19:11<1073::aid-pd702>3.0.co;2-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 28-year-old Taiwanese woman who had received ovulation induction by clomiphene citrate (CC), follicular-stimulating hormone (FSH), and human chorionic gonadotrophin (hCG) treatment was diagnosed with a quadruplet pregnancy containing a hydatidiform mole and three fetuses at nine weeks' gestation. Expectant management failed to achieve any viable neonate due to massive antepartum haemorrhage and preterm delivery at 25 weeks' gestation. Five other cases previously reported involving quadruplets or triplets with a complete hydatidiform mole and two or three fetuses are reviewed. All cases ended as premature non-viable fetuses. Analysis of the clinical features, management, and outcome both in our patient and these reports suggest that more efficacious treatment planning, such as selective feticide, should be considered in order to improve the likelihood of attaining an advanced gestational age for a single fetus.
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Affiliation(s)
- A S Chao
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, No. 5, Fuhsing Street, Kweishan, Taoyuan, Taiwan 333, Republic of China
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Van de Kaa CA, Robben JC, Hopman AH, Hanselaar AG, Vooijs GP. Complete hydatidiform mole in twin pregnancy: differentiation from partial mole with interphase cytogenetic and DNA cytometric analyses on paraffin embedded tissues. Histopathology 1995; 26:123-9. [PMID: 7737658 DOI: 10.1111/j.1365-2559.1995.tb00641.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Six cases of hydatidiform mole associated with normal chorionic villi and a normal embryo/fetus (in five cases) were investigated with interphase cytogenetic and DNA cytometric analyses for diagnostic purposes. DNA probes specific for the pericentromeric regions of chromosomes 1 and X and for the long arm of chromosome Y were used. In four cases a dizygotic twin pregnancy could be proven. In these cases, the histologically normal chorionic villi showed an XY DNA-diploid pattern, consistent with a normal male conceptus, and the molar chorionic villi a XX pattern. In the other two cases an identical sex chromosomal pattern was found in the normal and in the molar villi (XX/XX and XY/XY respectively). In all six cases the molar placental tissues showed prominent trophoblastic hyperplasia with DNA-polyploidy, consistent with a complete hydatidiform mole. In two cases persistent gestational trophoblastic disease developed. It is emphasized that twin pregnancies composed of a normal conceptus and a complete mole have a relatively high risk for the development of persistent trophoblastic disease and therefore, should be carefully differentiated from triploid partial moles with a relatively low risk of persistent gestational trophoblastic disease. These case reports indicate that additional interphase cytogenetic and DNA cytometric analyses are useful in this differential diagnosis.
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Affiliation(s)
- C A Van de Kaa
- Institute of Pathology, University Hospital Nijmegen, The Netherlands
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Walker DJ, Cietak KA, Kennedy CR. Hydatidiform mole with a coexistent fetus after ovulation induction. J Assist Reprod Genet 1994; 11:107-9. [PMID: 7819704 DOI: 10.1007/bf02215997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- D J Walker
- Walsgrave Maternity Hospital, Coventry, United Kingdom
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