Double Trisomy 16 and 22 Clinically Mimic Partial Hydatidiform Mole in a Case of Subsequent Pregnancy Loss

A case of double trisomy 16 and 22 in the second pregnancy loss is presented. DNA analyses (short tandem repeats genotyping) of miscarriage specimen was indicated because of ultrasound suspicion of partial hydatidiform mole. After the partial hydatidiform mole exclusion, further DNA analyses focused on the most common aneuploidies causing pregnancy loss, detected double trisomy 16 and 22 in the product of conception. The couple was referred to clinical genetic consultation and normal parental karyotypes were proved. For further explanatory purposes, archived material from the first pregnancy loss was analyzed and trisomy of chromosome 18 was detected. By comparison of allelic profiles of the mother, father, and both losses, the maternal origin of all aneuploidies was proven what can be attributed to frequent meiosis errors, probably due to advanced maternal age (44 years at the first loss and 45 years at the second loss). In conclusion, aneuploidies can mimic partial hydatidiform mole. Genetic analysis is helpful on the one hand to rule out partial hydatidiform mole and on the other hand to identify aneuploidies and in this way to determine the cause of miscarriage.

PTEN mutations as predictive marker for the high-grade endometrial cancer development in slovak women

Endometrial carcinoma (ECa) is one of the most common neoplasia of the female genital tract. The phosphatase and tensin (PTEN) homolog is the most frequently mutated tumor suppressor gene in endometrial carcinoma. PTEN encodes a phosphatase, a key regulatory enzyme involved in a signal transduction pathway that regulates cell growth, migration and apoptosis. The study evaluates an association between the morphological appearance of endometrial hyperplasia and ECa, and the presence of PTEN variations, PTEN protein level and intracellular localization. A total of 67 archived formalin-fixed and paraffin-embedded human biopsy tissue specimens with normal proliferative and secretory endometrium, endometrial hyperplasia without atypia and endometrial atypical hyperplasia, endometrioid the grade G1 and G3 and serous subtype of ECa were evaluated by sequencing for the presence of mutations in coding regions of PTEN gene of endometrial epithelial cells. The PTEN gene expression and intercellular localization of PTEN protein were evaluated immunohistochemically by immunoreactive score (IRS). PTEN mutation spectrum in endometrial carcinoma was identified for Slovak population. Twenty-eight non-silent mutations were identified in PTEN, twelve of them being novel, not annotated in Catalogue of Somatic Mutations in Cancer. Higher frequency of PTEN mutations was observed in serous carcinoma compared to global average. No correlation was observed between samples IRS, PTEN cellular localization and identified mutations. PTEN sequencing can be beneficial for patients considering prognosis of disease and sensitivity to treatment.

Importance of the genetics in the diagnostics of hydatidiform mole

OBJECTIVE

To summarize the possibilities of the genetic analysis of hydatidiform moles and point out its perspectives in the diagnostics of this disease.

DESIGN

Review.

SETTING

Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Slovak Republic.

METHODS

Analysis of published literature data from the internet databases PubMed, ScienceDirect, Scopus and printed literature from the period 1963-2019.

RESULTS

This review refers on karyotyping, flow cytometry, FISH (Fluorescent in Situ Hybridization), VNTR-RFLP analysis (Variable Number of Tandem Repeats-Restriction Fragment Length Polymorphism), VNTR-PCR analysis (Variable Number of Tandem Repeats-Polymerase Chain Reaction) and STR (Short Tandem Repeat) genotyping of hydatidiform moles. The article summarizes possible application of these methods in the differential diagnostics of molar pregnancy (partial and complete hydatidiform moles) and nonmolar hydropic abortions.

CONCLUSION

Genetic analyses offer precise identification of types of molar pregnancies when histopathological diagnosis is not clear during early stages of pathology.

The International Network of Obstetric Survey System

OBJECTIVE

To informed about international surveillance network severe maternal morbidity and mortality - INOSS.

DESIGN

Literature review.

SETTINGS

1st Department of Gynaecology and Obstetrics Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic.

METHODS

Literate review of articles published till august 2019.

RESULTS

The International Network of Obstetric Survey Systems (INOSS) is an international network that connects countries with the same or similar system of surveillance of acute severe maternal morbidity and mortality. The INOSS was established in year 2010 by twelve countries. Nowadays 19 countries are involved in the INOSS. The cooperation between member countries is focused on the acquisition of relevant data about rare severe acute maternal morbidities. INOSS in 2017 year unified definitions of 8 severe acute maternal morbidities according Delphi method: eclampsia, amniotic fluid embolism, peripartum hysterectomy, severe primary postpartum haemorrhage, uterine rupture, abnormally invasive placenta, spontaneous hemoperitoneum in pregnancy, and cardiac arrest in pregnancy.

CONCLUSION

The international cooperation allows the acquisition of relevant epidemiologic data and the optimalization of the treatment according the evidence-based medicine.

Postpartum ovarian vein thrombosis: case report and review of literature

OBJECTIVE

An analysis of POVT (postpartum ovarian vein thrombosis) case, the importance of prompt diagnosis, antibiotic and anticoagulation therapy management with multidisciplinary team approach.

DESIGN

A case report and literature review.

SETTING

1st Department of Gynaecology and Obstetrics, Faculty of Medicine Comenius University and University Hospital, Bratislava, Slovakia.

METHODS AND RESULTS

Authors would like to draw attention to the pitfalls of diagnosis and treatment of postpartum ovarian vein thrombosis with combination of antibiotics and anticoagulants after uncomplicated vaginal delivery.

CONCLUSION

Due to potentially life-threatening postpartum complications such as sepsis and pulmonary embolism, prompt diagnosis and treatment of POVT are important. To detection of POVT are MRI and CECT associated with higher sensitivity and specificity compared to colour Doppler ultrasound. For symptomatic POVT many authors suggest anticoagulation for 3 to 6 months (until there is radiologically confirmed thrombus resolution) with the addition of antibiotics for 7 to 10 days (in the case of suspected infection). Multidisciplinary approach is important.

Maternal morbidity and mortality in Slovak Republic in the years 2007-2015

OBJECTIVE

Analysis of maternal morbidity and mortality in Slovak Republic in the years 2007-2015.

DESIGN

Prospective epidemiological perinatological nation-wide.

SETTINGS

1st Department of Gynaecology and Obstetrics Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic.

METHODS

The analysis of selected maternal morbidity and mortality data prospective collected in the years 2007-2015.

RESULTS

Cesarean section rate progressively increased from 24.1% in the year 2007 up to 30.8% in the year 2013 and up to year 2015 decreased to 30.2%. Vacuum-extraction frequency was 1.3% in the year 2007 and to the year 2015 increased up to 1.6%. Forceps frequency was the same in the year 2007 and 2015: 0.6%. In the years 2008-2015 frequency of perineal tears 3th and 4th degree increased from 0.44% to 0.68% and frequency of episiotomies decreased from 74.7% to 57.2%. In the years 2012-2015 incidence of total severe acute maternal morbidity per 1,000 births was 5.85, peripartum hysterectomy 0.78, severe postpartum bleeding 2.03, transport to anaesthesiology department/intensive care unit 1.26, eclampsia 0.2, HELLP syndrome 0.6, abnormal placental invasion 0.38, uterine rupture 0.45, severe sepsis in pregnancy and puerperium 0.14 and frequency of nonfatal amniotic fluid embolism was 2/100,000 maternities. Total maternal mortality ratio in this period was 11.5 and pregnancy-related deaths ratio 9.9 per 100,000 live births.

CONCLUSION

The highest cesarean section rate in Slovakia, 30.8 %, was in the year 2013, but in the next years slowly decreased. Frequency of episiotomies decreased in followed period too. Incidence of severe acute maternal morbidity was 5.85 per 1,000 births. Maternal mortality ratio in Slovakia was one of the highest in European Union and not corresponding with good level of perinatal mortality. Improving of cesarean section rate and episiotomy, incidence of severe acute maternal morbidity and maternal mortality still need to be improved in Slovak Republic.

Perinatal mortality and morbidity in Slovak Republic in the years 2007-2015

OBJECTIVE

Comparison of perinatal mortality in Slovak Republic in three periods during the years 2007-2015.

DESIGN

Epidemiological perinatal nation-wide.

SETTINGS

1st Department of Gynaecology and Obstetrics Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic.

METHODS

The analysis of prospectively collected selected perinatal data in the years 2007-2015.

RESULTS

In the year 2007 there were 63 obstetrics units, 51,146 deliveries and that of live births 51,650 in Slovak Republic. The number of obstetrics units decreased to 54 in the years 2015, but total number of deliveries increased to 55,139 and that of live births increased to 55,643. Preterm deliveries rate increased from 7.3% in the year 2007 to 8.5% in the year 2010 and decreased to 7.5% in the year 2015. Perinatal mortality rate decreased from 6.2 in the year 2007 to 4.8 in the year 2013, and increased again in the years 2014 and 2015 to 5.3 and 5.6 per 1,000 still- and live-births respectively. During the years 2007-2015 stillbirth participate at perinatal mortality with 64%, low birth weight with 64% and severe congenital anomalies with 20%. Transport in utero to perinatological centres in the years 2007-2015 has increased from 57% to 66% for infants 1000-1499 g and from 75% to 79% for infants below 1000 g.

CONCLUSION

In the year 2013 perinatology in Slovak Republic reached the best result in perinatal mortality rate 4.8 (0.48%), but in next two years has increased over 5. Prenatal detection of severe congenital abnormalities, transport in utero very low birth weight infants, centralisation of high-risk pregnancies and obstetric and neonatal intensive care units equipment need still to be improved in Slovak Republic. Keywords perinatal mortality, preterm delivery, multiple pregnancy, neonatal intensive care unit, low birth weight, very low birth weight.

[Analysis of maternal morbidity and mortality in Slovak Republic in the years 2007-2012]

OBJECTIVE

Analysis of maternal morbidity and mortality in Slovak Republic (SR) in the years 2007-2012.

DESIGN

Epidemiological perinatological nation-wide.

SETTINGS

1st Department of Gynaecology and Obstetrics School of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic.

METHODS

The analysis of selected maternal morbidity and mortality data prospective collected in the years 2007-2012 from all obstetrics hospitals in the Slovak Republic.

RESULTS

Caesarean section rate progressively increased from 24.1% in the year 2007 up to 30.3% in the year 2012. In the year 2012 the frequency of vacuum-extraction was 1.4%, forceps 0.6%, perineal tears 3th and 4th degree 0.49% and episiotomy 65%. Incidence of total severe acute maternal morbidity was 6.34 per 1,000 births. Incidence (per 1,000 births) of transport to anaesthesiology department/intensive care unit was 2.32, postpartum hysterectomy 0.72, HELLP syndrome 0.63, eclampsia 0.29, abnormal placental invasion 0.37, uterine rupture 0.27, severe sepsis in pregnancy and puerperium 0.21. In the years 2007-2012 frequency of fatal amniotic fluid embolism was 2.46/100,000 maternities or 2.43/100,000 live-births. Maternal mortality ratio in this period was 14 per 100,000 live births and pregnancy-related deaths ratio was 11.9 per 100,000 live births.

CONCLUSION

In the year 2012 Slovakia reached the highest caesarean section rate in her own history - 30.3%. Incidence of severe acute maternal morbidity was 6.34 per 1,000 births. Maternal mortality ratio in Slovakia was one of the highest in European Union. Decreasing of caesarean section rate and episiotomy, incidence of severe acute maternal morbidity and maternal mortality still need to be improved in Slovak Republic.

[Comparison of perinatal mortality in Slovak Republic in the years 2007-2009 and in the years 2010-2012]

OBJECTIVE

Comparison of perinatal mortality in Slovak Republic in the years 2007-2009 and in the years 2010-2012.

DESIGN

Epidemiological perinatal nation-wide.

SETTING

1st Department of Gynaecology and Obstetrics School of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic.

METHODS

The analysis of selected perinatal data prospectively collected in the years 2007-2009 and in the years 2010-2012.

RESULTS

In the year 2007 there were 63 maternity hospitals, 51,146 deliveries and that of live births 51,650 in Slovak Republic. In the years 2010-2012 decreased the number of maternity hospitals, total number of deliveries and that of live births from 57 to 55, from 55,362 to 54,996 and from 55,901 to 55,643 respectively. Preterm deliveries rate increased from 7.4 to 7.7% and multiple pregnancies rate from 1.4% to 1.5% in the years 2010-2012 compared to years 2007-2009. Perinatal mortality rate decreased from 6.2 in the year 2007 to 5.1 per 1,000 still and live births in the year 2012. During the years 2007-2012 stillbirth participate in perinatal mortality 64%, low birth weight 65% and severe congenital anomalies 19%. Transport in utero to perinatal centres decreased in the years 2007-2012. It was from 64% to 56% for infants with very low birth weight and from 75% to 70% for infants with extremely low birth weight.

CONCLUSION

In the year 2012 Slovak perinatology reach the best result in perinatal mortality rate 5.1 (0.51%). Centralisation of high-risk pregnancies, transport in utero very low birth weight infants, prenatal detection of severe congenital abnormalities and obstetric and neonatal intensive care units equipment need still to be improved in Slovak Republic.

[Results of gestational trophoblastic neoplasia treatment in the Slovak Republic in the years from 1993 to 2012]

OBJECTIVE

Analysis and epidemiology of gestational trophoblastic neoplasia treatment in the Slovak Republic in the years 1993-2012.

DESIGN

Retrospective epidemiological national study.

SETTING

Centre for gestational trophoblastic disease Ministry of Health the Slovak Republic, Bratislava.

METHODS

Retrospective analysis results of gestational trophoblastic neoplasia treatment according to prognostic scoring and staging system FIGO/WHO in Centre for gestational trophoblastic disease Ministry of Health the Slovak Republic Bratislava in the years 1993-2012.

RESULTS

The treatment of gestational trophoblastic neoplasia (GTN) in the Czech and Slovak Republics started in 1955 and lasted till 1993. After the split of the former Czechoslovakia the Centre for gestational trophoblastic disease was created in Slovakia. 75 patients were treated in this Centre in the years 1993-2012. According to prognostic scoring and staging system FIGO/WHO 56 (75%) patients had low-risk gestational trophoblastic neoplasia and 19 (25%) of patients had high-risk gestational trophoblastic neoplasia. There were 41 patients (55%), 2 (3%), 24 (32%) and 8 (11%) in stage I., II., III. and IV. respectively. Total curability rate was 94.7% and mortality rate was 5.3%. Curability rate 100% was achieved in stage I & II and all placental site trophoblastic tumours (PSTT), 98.3% in stage III and 50% stage IV. In the years 1993-2012 the incidence of choriocarcinoma was one in 76 273 pregnancies and one in 53 203 deliveries. The incidence of other gestational trophoblastic neoplasia in the same years was for PSTT one in 533 753 pregnancies and one in 372 422 deliveries, invasive mole one in 145 611 pregnancies and one in 101 569 deliveries, and persistent GTN one in 40 043 pregnancies and one in 27 932 deliveries. 225-241 patients were treated in the same period of time in the Czech Republic with curability rate 98.2-98. 3%.

CONCLUSION

Early detection and treatment in the centre for trophoblastic disease are crucial points in the manage-ment of gestational trophoblastic neoplasia, because the effective therapy of gestational trophoblastic neoplasia with high curability rate is available.

[Characteristics of sexual maturation in girls in Bratislava region]

OBJECTIVE

Evaluation of puberty onset and menarche in girls in Bratislava region in the years 2006-2007 and 2011-2013.

DESIGN

Regional retrospective epidemiological study.

SETTING

1st Department of Gynaecology and Obstetrics, School of Medicine, Comenius University and University Hospital Bratislava, Slovenské republika.

METHODS

A study in two periods was performed. The first was in the years 2006-2007 and the second in 2011-2013. Together 217 girls aged 7-16 were enrolled. Secondary sexual characteristics according to Tanner were evaluated. Ultrasound examination of the uterus and ovaries was performed. The results were statistically evaluated by software Statistical Package for Social Sciences (SPSS) by age, and compared to results of Slovak study held in the years 1976-1980.

RESULTS

The mean age of menarche onset of girls in the group was 12.37. Pubarche and adrenarche onset were at 10.7 and 11.7 year respectively. Thelarche onset was at 10.9 year. Development of secondary sexual characteristics significantly correlated with ultrasound parameters of internal genitalia and with age of menarche. Average ultrasound parameters increases with age to 15 years. Significant changes were for average anteroposterior uterine size in 11 and 13 years old girls, for proportion corpus/cervix of the uterus in 9 and 11 years old girls and for average ovarian volume in 9, 11, 14 and 15 years old girls.

CONCLUSION

The results from our study comparing to those from study held in 1976-1980 shows continuous secular trend in Bratislava region.

KEYWORDS

age of menarche, secular trend, puberty, secondary sexual characteristics.

[Expression of p57 marker in differential diagnosis of complete and partial mole - correlation with DNA analysis]

Nowadays valid classification of gestational trophoblastic disease, according to the World Health Organisation from the year 2003, divides gestational trophoblastic disease into three groups - molar pregnancies, non-neoplastic non-molar changes of trophoblast and tumours of trophoblast. To the molar pregnancies belong complete, partial, invasive and metastatic hydatidiform mole. In the differential diagnosis it is important to distinguish the complete hydatidiform mole from other forms of gestational trophoblastic disease, because there is an increased risk of malignant transformation of trophoblast cells in complete hydatidiform mole. 10 cases of genetically confirmed diploid complete mole and 10 cases of genetically confirmed triploid partial mole were included into our retrospective study. All cases were examined microscopically in the basic haematoxillin and eosin staining and immunohistochemically with the use of antibodies against human choriogonadotropin hormone, placental alkaline phosfatase and protein p57. Villous cytotrophoblast, stromal villous cells, extravillous trophoblast and decidual cells were p57 positive in all cases of partial hydatidiform mole. All 10 cases of complete hydatidiform mole were p57 negative in stromal villous cells and villous cytotrophoblast. P57 protein is a marker distinguishing complete hydatidiform moles from partial moles.