1.Sad fetus syndrome: A case report
Alan O. Kintanar III ; Darleen SJ Estuart ; Lynette L. Lasala
Philippine Journal of Obstetrics and Gynecology 2022;46(4):186-191
Sad fetus syndrome is a rare gestational trophoblastic disease wherein a hydatidiform mole coexists with a live fetus. We report a case of a 40‑year‑old G4P2 (2012) with 29 weeks gestational age who came in with vaginal bleeding and labor pains. A previous ultrasound done at 16 weeks of gestation showed a live fetus, a normal placenta, and a focal multicystic uterine mass. The beta‑human chorionic gonadotropin level was 1,500,000 mIU/mL. She delivered a live preterm female fetus weighing 900 g by partial breech extraction. The placenta was grossly normal. Postpartum hemorrhage secondary to uterine atony was encountered and a total hysterectomy with bilateral salpingectomy was performed. Cut section of the specimen revealed molar tissue at the anterofundal area with evidence of gross myometrial invasion. The histopathologic finding was consistent with a diagnosis of partial hydatidiform mole. This paper describes the incidence, pathology, clinical presentation, diagnosis, treatment, and postpartum course of this rare condition.
Hydatidiform Mole
2.Correlation of uterine artery Doppler flow velocimetry and β-human chorionic gonadotropin levels during postmolar evacuation surveillance: A pilot study in a tertiary hospital
Geraldine C. Posecion ; Veronica M. Deniega
Philippine Journal of Obstetrics and Gynecology 2024;48(1):22-30
Background:
During postmolar evacuation surveillance, beta-human chorionic gonadotropin (β-hCG) regression levels can predict invasive disease while Doppler ultrasound can assess in vivo tumor neovascularization and quantify uterine blood supply. As an ancillary tool to β-hCG monitoring, ultrasound can detect the early presence of viable trophoblastic tissues and identify patients at risk of developing postmolar gestational trophoblastic Neoplasia (PMGTN).
Objective:
The objective of this study was to correlate uterine artery Doppler ultrasound with β-hCG levels during pre- and postmolar evacuation surveillance among patients with complete mole.
Materials and Methods:
A cohort of patients with sonographic diagnosis of complete hydatidiform mole and managed with suction curettage in the same institution were prospectively followed up after evacuation. The pre- and postmolar evacuation surveillance period was at days 1, 7, 14, 21, 28, and 35. Monitoring of serum β-hCG levels was based on the standard regression curve. For Doppler ultrasound parameters, monitoring of the systolic/diastolic (S/D) ratio, pulsatility index (PI), resistance index (RI), and peak systolic velocity (PSV) was based on its relationship with its serum β-hCG levels. The ultrasound images generated were archived and reviewed by the authors. Descriptive and inferential statistics were utilized to analyze median differences. For the correlation of uterine artery Doppler flow parameters, analysis for the test of difference used Pearson correlation and multiple linear regression analysis for the odds ratio.
Results:
Sixteen of the 23 enrolled patients completed the protocol (16 of 23, 69.50%). A majority had spontaneous remission (13; 81%) while 3 cases (19%) presented increasing and plateauing β-hCG levels. The pre- and post evacuation median β-hCG levels showed a significant decrease (P = 0.001). As post evacuation β-hCG levels decreased, PSV also decreased (r = 0.478, P = 0.061) while Doppler parameters, RI, PI, and S/D ratio increased. However, when post evacuation β-hCG levels rose or plateaued, Doppler parameters decreased. These changes had statistical correlation (all P < 0.05). Moreover, the magnitude of the relationship for β-hCG and Doppler parameters was moderate and ranged from 0.524 to 0.581. Among the Doppler parameters, the S/D ratio and RI of the right uterine artery strongly predicted a rise in β-hCG levels. The odds ratio of predicting increased β-hCG levels and risk of gestational trophoblastic neoplasia by the right S/D ratio were − 2683.67 (confidence interval [CI] = −271.692–5095.655; P = 0.034) and by the right RI − 66,193.34 (CI = −161,818.107–29,431.433; P = 0.046). Notably, Doppler parameter changes appeared early at day 14 up to day 35 and before the appearance of abnormal β-hCG regression patterns.
Conclusion
There is a strong correlation between uterine artery Doppler flow changes and β-hCG levels during postmolar evacuation surveillance. The inverse relationship of the S/D ratio, PI and RI, and β-hCG regression patterns confirms spontaneous remission of the disease. For patients with abnormal β-hCG patterns, this relationship is altered. The Doppler changes become erratic, unpredictable, and significantly decreased. These changes were detected as early as 2 weeks post evacuation. Thus, the use of ultrasound as an adjunct to β-hCG post evacuation surveillance can predict abnormal β-hCG regression patterns and identify patients at risk of developing postmolar gestational trophoblastic neoplasia (PMGTN).
Hydatidiform Mole
;
Gestational Trophoblastic Disease
;
Hydatidiform Mole
3.Study on clinical characteristics and related factors of hydatidiform mole at Hue Central Hospital
Journal of Practical Medicine 2004;472(2):11-14
54 cases of hydatidiform mole pregnancy were studied at the Department of Gynecology and Obsterics of the Central Hospital from June 2000 to July 2001, in comparing with 124 cases of normal immature delivery of living neonate. A high rate of clinical symptoms were noted including vaginal hemorrhage in the first trimester, a more unterine height than in normal fetal age, anemia, severe vomit, pre-eclampsia, hyperthyroidism, luteino-adenoma cyst of > 5 cm diametre. There is a positive relation between vaginal bleeding, uterine height before the curettage and the state of luteino adenoma cyst with Chorio complication. Related factors of hydatidiform mole pregnancy were nutritional status, occupation, age, history of abortment and water source hygiene.
Diagnosis
;
Hydatidiform Mole
;
Pregnancy
4.Some epidemiological factors in hydatidiform mole.
Soo Mee LEE ; Eun Ju KIM ; Kyung Hee RHO ; Jee Yeon KIM ; Barbara H MARTIN
Korean Journal of Obstetrics and Gynecology 1993;36(7):1594-1601
No abstract available.
Female
;
Hydatidiform Mole*
;
Pregnancy
5.Complete hydatidiform mole with co-existing live fetus: A case report
Jezzel Joice G. Lagare ; Lynnette R. Lu-Lasala
Philippine Journal of Obstetrics and Gynecology 2020;44(4):25-28
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.
Pregnancy
;
Female
;
Hydatidiform Mole
6.Placental mosaicism in multiple gestation: Complete hydatidiform mole with coexisting twin fetus.
Agnes L. Soriano-Estrella ; Victoria May H. Velasco-Redondo
Acta Medica Philippina 2024;58(11):81-89
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.
Hydatidiform Mole
;
Pregnancy, Twin
7.A Case of Complete Hydatidiform Mole with Coexisting Surviving Fetus.
Soon Sook NAH ; Suk Nyun BAE ; Jae Sun KIM ; Chul Hoon PARK ; Hae Nam LEE ; Sung Eun NAMGOONG
Korean Journal of Obstetrics and Gynecology 2000;43(8):1469-1472
No abstract available.
Female
;
Fetus*
;
Hydatidiform Mole*
;
Pregnancy
8.Genetic classification of hydatidiform mole using restriction fragment length polymorphisms(RFLPs).
Jong Chul SONG ; Eung Jung BAIK ; Woo Ik SON ; Ki Sung YOO ; Joon Mo LEE ; Jae Keun JUNG ; Seung Jo KIM ; Hun Young LEE
Journal of the Korean Cancer Association 1993;25(4):556-562
No abstract available.
Classification*
;
Female
;
Hydatidiform Mole*
;
Pregnancy
9.A case of trophoblastic pulmonary embolization associated with hydatidiform mole.
Sang Jin KIM ; Byung Min LEE ; Dong Hee PARK ; Man Soo YOON ; Won Whe KIM
Korean Journal of Obstetrics and Gynecology 1993;36(9):3529-3534
No abstract available.
Female
;
Hydatidiform Mole*
;
Pregnancy
;
Trophoblasts*
10.The use of uterine artery Doppler studies as predictors for postmolar gestational trophoblastic neoplasia
Maria Febi Billones De Ramos ; Lara Marie David Bustamante ; Elizabeth Karunungan Jacinto
Philippine Journal of Obstetrics and Gynecology 2023;47(3):108-120
Background:
Gestational trophoblastic neoplasia (GTN) is considered one of the most curable
malignancies, especially when diagnosis and treatment are commenced early. Identifying predictors
for the development of GTN will enable prompt management equating to an excellent prognosis.
Objectives:
The objectives of this study were to determine the validity of uterine artery Doppler
parameters (UADPs) as predictors for postmolar GTN, compare UADP values before and after
evacuation, determine cutoff values and relationship with beta‑human chorionic gonadotropin (hCG)
levels.
Materials and methods:
This was a prospective cohort study, which included histopathologically
confirmed hydatidiform mole (HM) patients who underwent suction curettage. UADPs (pulsatility
index (PI), resistive index, and systolic/diastolic [S/D] ratio) were measured preevacuation, 4 weeks
postevacuation, and 6 weeks postevacuation. Patients were followed up to determine whether they
will develop postmolar GTN or not.
Results:
A total of 31 HM patients were admitted during the study period, 84% (26/31) of whom
underwent suction curettage. Of these, 92% (24/26) had histopathology of complete HM and were
recruited. However, only 17 patients followed up and completed the study. Results showed that
there was an increasing trend of the UADP from preevacuation to 6 weeks postevacuation and the
trend between those with and without postmolar GTN was statistically significant. There was also
an inverse relationship between the UADP and baseline β‑hCG values. UADP showed lower values
among patients who developed postmolar GTN compared to those who did not. The cutoff values
recommended by the area under curve (AUC) that can be a possible predictor were 4th‑week right PI
of 2.14 (AUC = 0.71) and right S/D ratio of 2.60 (AUC = 0.73) and 6th‑week left PI of 2.80 (AUC = 0.70)
and right PI of 2.53 (AUC = 0.74).
Conclusion
Neoangiogenesis, a hallmark of malignancy, is correlated with invasive disease and
will show increased myometrial vascularization with lower uterine artery indices. Doppler ultrasound
may be a useful tool for postmolar follow‑up and GTN diagnosis. However, the small sample size in
this study is a limitation and a larger multicenter study is recommended.
Gestational Trophoblastic Disease
;
Hydatidiform Mole