The clinical presentation, treatment, and outcome of patients diagnosed with possible ectopic molar gestation

2004 ◽  
Vol 14 (2) ◽  
pp. 366-369 ◽  
Author(s):  
A. M. Gillespie ◽  
E. A. Lidbury ◽  
J. A. Tidy ◽  
B. W. Hancock
Keyword(s):  
Risk Factors ◽  
Clinical Presentation ◽  
Gestational Trophoblastic Disease ◽  
Surgical Removal ◽  
Molar Pregnancy ◽  
Initial Management ◽  
Trophoblastic Disease ◽  
Treatment Centre ◽  
History Of ◽  
Park Hospital

The objective of this study was to determine the clinical presentation, treatment, and outcome of patients diagnosed with possible ectopic molar gestation registered with the Trophoblastic Disease Screening and Treatment Centre, Weston Park Hospital, Sheffield between 1986 and 2000. From the 5581 women registered, those with a diagnosis of ectopic molar pregnancy were identified from a computer database. Information regarding the relevant history of each patient and the clinical presentation, treatment, and outcomes of gestational trophoblastic disease (GTD) was determined by reviewing referral forms, case notes, and pro formas completed by the referring gynecologist. Histological review of the cases was undertaken where possible. Suspected ectopic molar gestations comprised 31/5581 (0.55%) of registrations. Known risk factors for ectopic pregnancy were identified in 79% of cases. Central histological review confirmed only six cases of GTD: three choriocarcinoma and three early complete moles. Four patients subsequently required chemotherapy. All patients are now in complete remission. We conclude that ectopic GTD is uncommon, with a UK incidence of approximately 1.5 per 1,000,000 births. Initial management is usually surgical removal of the conceptus, pathological suspicion of the diagnosis and registration with a screening center. Chemotherapy may be required and the prognosis is excellent.

Pregnancy-Related Emergencies

2019 ◽  
Author(s):  
Amy Hideko Kaji
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Hyperemesis Gravidarum ◽  
Gestational Trophoblastic Disease ◽  
Treatment Modalities ◽  
Free Fluid ◽  
Molar Pregnancy ◽  
Hypertensive Disorders Of Pregnancy ◽  
Trophoblastic Disease ◽  
Hypertensive Disorders

This review provides an overview of spontaneous abortion, ectopic pregnancy, gestational trophoblastic disease or molar pregnancy, hyperemesis gravidarum, placental abruption, placental previa, hypertensive disorders of pregnancy, and amniotic fluid embolism. Assessment and stabilization, diagnosis, treatment and disposition, and outcomes are discussed. Tables include classifications of abortion or miscarriage, differential diagnosis of patients presenting with vaginal bleeding during pregnancy, risk factors for ectopic pregnancy, treatment modalities for hyperemesis gravidarum, classification of hypertensive disorders of pregnancy, and risk factors for preeclampsia and eclampsia. Figures show ectopic pregnancy on a sonogram, free fluid in hepatorenal fossa on a focused abdominal sonogram in trauma, double decidual sign in a normal intrauterine pregnancy, pseudogestational sac in an ectopic pregnancy, and “snowstorm” appearance of molar pregnancy on a sonogram. This review 5 figures, 13 tables, and 68 references. Keywords: abortion, ectopic, gestational trophoblastic disease, abruption, previa, ecclampsia

scholarly journals SUN-513 Severe Hyperthyroidism in a Complete Molar Pregnancy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Nikoletta Proudan ◽  
Kersthine Andre
Keyword(s):  
Perioperative Complications ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Thyroid Storm ◽  
Molar Pregnancy ◽  
Free T4 ◽  
Trophoblastic Disease ◽  
Increased Risk ◽  
History Of

Abstract Hydatidiform mole (HM), a type of gestational trophoblastic disease (GTD), is a rare cause of clinical hyperthyroidism. The development of hyperthyroidism requires an elevation of HCG >100,000 mlU/mL for several weeks. Complete mole has a marked HCG elevation compared to partial mole thus presents with a higher incidence of thyrotoxicosis. Surgical uterine evacuation is the treatment of choice for HM. However, untreated hyperthyroidism can pose a risk for the development of thyroid storm and high-output cardiac failure in the perioperative period. To our knowledge, there are no specific guidelines for management at this time. We present a case of hyperthyroidism secondary to complete molar pregnancy successfully treated with propylthiouracil (PTU), potassium iodide (SSKI), and atenolol in the preoperative period. A 42-year-old female with history of migraines presented to her gynecologist with a 3-week history of lower abdominal cramping, vomiting, loss of appetite, and abnormal vaginal bleeding. She also endorsed a 6-pound weight loss, intermittent tachycardia, exertional dyspnea, and increased anxiety. Pregnancy test was positive, and ultrasound was concerning for GTD. Laboratory work up was significant for HCG 797,747 mIU/mL (< 5mlU/mL), TSH <0.005 mIU/mL (0.4-4.0 mlU/mL), Free T4 3.09 ng/dL (0.9-1.9 ng/dL), and Free T3 11.48 pg/dL (1.76-3.78 pg/dL). The patient was admitted to the hospital and started on PTU 100 mg Q6H, SSKI 200 mg TID following the first dose of PTU, and atenolol 25 mg daily. She underwent an uncomplicated D & C the next day. On post-op day 1, HCG decreased to 195,338 mIU/mL and Free T4 to 2.39 ng/dL. The patient was discharged on the aforementioned doses of PTU and atenolol. One-week follow-up labs showed HCG 8,917 mIU/mL and Free T4 1.22 ng/dL. Surgical pathology confirmed a complete hydatidiform mole. PTU was decreased to 50 mg TID. On post-op day 14, HCG had risen to 15,395 mIU/mL with onset of nausea and vomiting. Repeat Free T4 remained within reference range. Patient was taken back to surgery for a laparoscopic total hysterectomy with bilateral salpingectomy. Pathology confirmed an invasive hydatidiform mole. Two-week follow-up lab work showed HCG 155 mIU/mL, TSH 1.5 mIU/mL, and Free T4 1.19 ng/dL. PTU and atenolol were then discontinued. The development of hyperthyroidism in molar pregnancy is largely influenced by the level of HCG and usually resolves with treatment of GTD (1). However, it’s crucial to control thyrotoxicosis to avoid perioperative complications. This case also highlights the importance of monitoring HCG levels following a complete molar pregnancy due to an increased risk for invasive neoplasm. 1. Walkington, L et al. “Hyperthyroidism and human chorionic gonadotrophin production in gestational trophoblastic disease.” British journal of cancer vol. 104,11 (2011): 1665-9. doi:10.1038/bjc.2011.139

scholarly journals Incidence and outcome of gestational trophoblastic disease in lower Egypt

2020 ◽  
Vol 20 (1) ◽  
pp. 73-82
Author(s):  
Ahmed Zakaria ◽  
Reda Hemida ◽  
Waleed Elrefaie ◽  
Ehsan Refaie
Keyword(s):  
Risk Factors ◽  
Patient Characteristics ◽  
Gestational Trophoblastic Disease ◽  
Treatment Modalities ◽  
Progression Rate ◽  
Molar Pregnancy ◽  
Live Births ◽  
Trophoblastic Disease ◽  
Rate Of Progression ◽  
Incidence Risk

Background. Gestational trophoblastic disease (GTD) defines a spectrum of proliferative disorders of trophoblastic epitheli- um of the placenta. Incidence, risk factors, and outcome may differ from one country to another. Objective. To describe incidence, patient characteristics, treatment modalities, and outcome of GTD at Mansoura University which is a referral center of Lower Egypt. Methods. An observational prospective study was conducted at the GTD Clinic of Mansoura University. The patients were recruited for 12 months from September 2015 to August 2016. The patients’ characteristics, management, and outcome were reported. Results. We reported 71 clinically diagnosed GTD cases, 62 of them were histologically confirmed, 58 molar (33 CM and 25 PM) in addition to 4 initially presented GTN cases. Mean age of the studied cases was 26.22 years ± 9.30SD. Mean pre-evacu- ation hCG was 136170 m.i.u/ml ±175880 SD. Most of the cases diagnosed accidentally after abnormal sonographic findings (53.2%). Rate of progression of CM and PM to GTN was 24.2% and 8%, respectively. Conclusion. The incidence of molar pregnancy and GTN in our locality was estimated to be 13.1 and 3.2 per 1000 live births respectively. We found no significance between CM and PM regarding hCG level, time to hCG normalization, and progression rate to GTN. Keywords. Molar pregnancy; incidence; outcome.   

scholarly journals Clinicopathological study of Gestational Trophoblastic Disease

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 2344-2349
Author(s):  
Ramesh M. Oswal ◽  
Mahendra A. Patil ◽  
Sujata M. Kumbhar ◽  
Jyoti S. Tele ◽  
Atul B. Hulwan
Keyword(s):  
Risk Factors ◽  
Maternal Age ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Histopathological Study ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Trophoblastic Disease ◽  
Complete Mole ◽  
Clinicopathological Study

Several potential etiologic risk factors have been evaluated for the development of complete hydatidiform mole. The two established risk factors that have emerged are extremes of maternal age and prior molar pregnancy. Advanced or very young maternal age has consistently correlated with higher rates of complete hydatidiform mole. Compared to women aged 21- 35 years, the risk of a complete mole is 1.9 times higher for women both more than 35 years and less than 21 years as well as 7.5 times higher for women more than 40 years. (49, 50) The risk of repeat molar pregnancy after 1 mole is about 1% or about 10-20 times the risk for the general population. The present study on the gestational trophoblastic disease (GTD) was carried out as it is one of the fascinating gynaecological tumours. Hence a clinicopathological study of gestational trophoblastic disease was undertaken with relevance to the histopathological study of GTD and clinical correlation.

Changing Trends in the Clinical Presentation and Management of Complete Hydatidiform Mole Among Brazilian Women

2016 ◽  
Vol 26 (5) ◽  
pp. 984-990 ◽  
Author(s):  
Antonio Braga ◽  
Valéria Moraes ◽  
Izildinha Maestá ◽  
Joffre Amim Júnior ◽  
Jorge de Rezende-Filho ◽  
...  
Keyword(s):  
Natural History ◽  
Early Diagnosis ◽  
Clinical Symptoms ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Gestational Trophoblastic Neoplasia ◽  
Complete Hydatidiform Mole ◽  
Trophoblastic Disease ◽  
History Of

ObjectiveThe aim of the study was to evaluate potential changes in the clinical, diagnostic, and therapeutic parameters of complete hydatidiform mole in the last 25 years in Brazil.MethodsA retrospective cohort study was conducted involving the analysis of 2163 medical records of patients diagnosed with complete hydatidiform mole who received treatment at the Rio de Janeiro Reference Center for Gestational Trophoblastic Disease between January 1988 and December 2012. For the statistical analysis of the natural history of the patients with complete molar pregnancies, time series were evaluated using the Cox-Stuart test and adjusted by linear regression models.ResultsA downward linear temporal trend was observed for gestational age of complete hydatidiform mole at diagnosis, which is also reflected in the reduced occurrence of vaginal bleeding, hyperemesis and pre-eclampsia. We also observed an increase in the use of uterine vacuum aspiration to treat molar pregnancy. Although the duration of postmolar follow-up was found to decline, this was not accompanied by any alteration in the time to remission of the disease or its progression to gestational trophoblastic neoplasia.ConclusionsEarly diagnosis of complete hydatidiform mole has altered the natural history of molar pregnancy, especially with a reduction in classical clinical symptoms. However, early diagnosis has not resulted in a reduction in the development of gestational trophoblastic neoplasia, a dilemma that still challenges professionals working with gestational trophoblastic disease.

scholarly journals Gestational Trophoblastic Disease Spectrum: Case Report and Anaesthetic Implications

2020 ◽  
Vol 6 (3) ◽  
Keyword(s):  
Hydatidiform Mole ◽  
Asian Population ◽  
Anaesthetic Management ◽  
Gestational Trophoblastic Disease ◽  
Definitive Treatment ◽  
Surgical Removal ◽  
Molar Pregnancy ◽  
Rare Type ◽  
Trophoblastic Disease ◽  
Disease Spectrum

Gestational Trophoblastic Disease (GTD) is a spectrum of tumours with abnormal placental trophoblastic proliferation. They can be benign or malignant lesions. When they invade locally or metastasise, they are called Gestational Trophoblastic Neoplasia (GTN). Clinically, women present with history of amenorrhoea, abdominal pain, mild to severe vaginal bleed with or without symptoms due to metastases. Based on the organ of metastasis, symptoms may vary from breathlessness and cough with chest involvement to lethargy, loss of memory or seizures with brain metastasis. This entity ranges from pre-malignant conditions like hydatidiform mole and partial hydatidiform mole to neoplastic invasive mole, choriocarcinoma or rare type of epitheloid trophoblastic tumour. [1,2] Undetected hyperthyroidism can complicate GTD and present with potential significant complications like cardiac failure and arrhythmias. Manifestations of the disease are attributed to excess secretion of human chorionic gonadotropin (HCG) that has thyrotrophic activity due to its structural similarity. [3,4] The incidence reported in Asian population is as high as 1:400, three times higher. In majority of cases, early diagnosis and treatment provide complete cure in GTD. In 20%, even locally invasive disease, with or without metastasis can be life threatening. [5] Surgical removal is the definitive treatment. Peri-operative anaesthetic management of patients with multiple system involvement as a result of extensive disease can be challenging, hence from anaesthetic perspective it is essential to understand the pathophysiology, clinical presentations and potential complications of molar pregnancy. We hereby report successful management of two cases presenting at different areas of the disease spectrum. Keywords: Molar pregnancy; Choriocarcinoma; Tropoblastic disease.

Pregnancy-Related Emergencies

2019 ◽  
Author(s):  
Amy Hideko Kaji
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Hyperemesis Gravidarum ◽  
Gestational Trophoblastic Disease ◽  
Treatment Modalities ◽  
Free Fluid ◽  
Molar Pregnancy ◽  
Hypertensive Disorders Of Pregnancy ◽  
Trophoblastic Disease ◽  
Hypertensive Disorders

This review provides an overview of spontaneous abortion, ectopic pregnancy, gestational trophoblastic disease or molar pregnancy, hyperemesis gravidarum, placental abruption, placental previa, hypertensive disorders of pregnancy, and amniotic fluid embolism. Assessment and stabilization, diagnosis, treatment and disposition, and outcomes are discussed. Tables include classifications of abortion or miscarriage, differential diagnosis of patients presenting with vaginal bleeding during pregnancy, risk factors for ectopic pregnancy, treatment modalities for hyperemesis gravidarum, classification of hypertensive disorders of pregnancy, and risk factors for preeclampsia and eclampsia. Figures show ectopic pregnancy on a sonogram, free fluid in hepatorenal fossa on a focused abdominal sonogram in trauma, double decidual sign in a normal intrauterine pregnancy, pseudogestational sac in an ectopic pregnancy, and “snowstorm” appearance of molar pregnancy on a sonogram. This review 5 figures, 13 tables, and 68 references. Keywords: abortion, ectopic, gestational trophoblastic disease, abruption, previa, ecclampsia

scholarly journals MOLAR ECTOPIC PREGNANCY;

2013 ◽  
Vol 20 (04) ◽  
pp. 638-641
Author(s):  
SHAMA CHAUDHARY ◽  
IQRA JANGDA ◽  
RUBINA HUSSAIN
Keyword(s):  
Ectopic Pregnancy ◽  
Iliac Fossa ◽  
Hydatidiform Mole ◽  
Gestational Trophoblastic Disease ◽  
Molar Pregnancy ◽  
Trophoblastic Disease ◽  
Beta Hcg ◽  
History Of ◽  
The Right

Ectopic molar pregnancy is a rare occurrence. Clinical diagnosis of a molar pregnancy is difficult but histopathology is thegold standard for diagnosis. The management of ectopic molar pregnancies consists of surgically removing the conceptus, follow up &chemotherapy, if required. We are reporting a case report of a 35-year-old married, nulliparous woman, admitted in emergency with a 6-week history of amenorrhea, severe abdominal pain & an episode of fainting at home. Per abdominal examination revealed tendernessover the right iliac fossa, with guarding & rigidity. Diagnosis of ruptured ectopic pregnancy was made.Emergency laparotomy was done.Histopathological examination, showed tubal ectopic pregnancy with partial hydatidiform mole & a separate corpus luteal cyst.She wasfollowed up with serial beta hCG which became normal within 1 month. Although ectopic molar pregnancy is a rare entity but all ectopicpregnancies should be examined histologically to rule out presence of gestational trophoblastic disease to plan follow-up accordingly inorder to avoid persistent gestational trophoblastic disease which has a chance of malignant conversion.The prognosis of ectopic molarpregnancies is the same as for other forms of gestational trophoblastic disease.

THE RISK FACTORS OF MOLAR PREGNANCY

2017 ◽  
pp. 53-58
Author(s):  
Lam Huong Le
Keyword(s):  
High Risk ◽  
Gestational Trophoblastic Disease ◽  
Living Standard ◽  
Control Group ◽  
Uterine Perforation ◽  
Molar Pregnancy ◽  
Health It ◽  
Pregnancy Risk ◽  
History Of ◽  
And Control

Objectives: Molar pregnancy is the gestational trophoblastic disease and impact on the women’s health. It has several complications such as toxicity, infection, bleeding. Molar pregnancy also has high risk of choriocarcinoma which can be dead. Aim: To assess the risks of molar pregnancy. Materials and Methods: The case control study included 76 molar pregnancies and 228 pregnancies in control group at Hue Central Hospital. Results: The average age was 32.7 ± 6.7, the miximum age was 17 years old and the maximum was 46 years old. The history of abortion, miscarriage in molar group and control group acounted for 10.5% and 3.9% respectively, with the risk was higher 2.8 times; 95% CI = 1.1-7.7 (p<0.05). The history of molar pregnancy in molar pregnancy group was 9.2% and the molar pregnancy risk was 11.4 times higher than control group (95% CI = 2.3-56.4). The women having ≥ 4 times births accounted for 7.9% in molar group and 2.2% in control group, with the risk was higher 3.8 times, 95% CI= 1.1-12.9 (p<0.05). The molar risk of women < 20 and >40 years old in molar groups had 2.4 times higher than (95% CI = 1.1 to 5.2)h than control group. Low living standard was 7.9% in molar group and 1.3% in the control group with OR= 6.2; 95% CI= 1.5-25.6. Curettage twice accounted for 87.5%, there were 16 case need to curettage three times. There was no case of uterine perforation and infection after curettage. Conclusion: The high risk molar pregnancy women need a better management. Pregnant women should be antenatal cared regularly to dectect early molar pregnancy. It is nessecery to monitor and avoid the dangerous complications occuring during the pregnancy. Key words: Molar pregnancy, pregnancy women

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