Prevalence and Factors Associated with Hydatidiform Mole among Patients Undergoing Uterine Evacuation at Mbarara Regional Referral Hospital

Objective. We sought to determine the prevalence of and factors associated with hydatidiform molar gestations amongst patients undergoing uterine evacuation at Mbarara Regional Referral Hospital (MRRH), Mbarara, Uganda. Methods. This was a cross-sectional study carried out from November 2016 to February 2017. All patients admitted for uterine evacuation for nonviable pregnancy were included. The study registered 181 patients. Data were collected on sociodemographics, medical conditions, obstetrics, and gynecological factors. The evacuated tissue received a full gross and histopathologic examination. Cases of pathologically suspected complete hydatidiform mole were confirmed by p57 immunohistochemistry. Data were analyzed using STATA 13. Results. The prevalence of hydatidiform mole was 6.1% (11/181). All detected moles were complete hydatidiform moles, and there were no diagnosed partial hydatidiform moles. Clinical diagnosis of molar pregnancy was suspected in 13 patients, but only 69.2% (9/13) were confirmed as molar pregnancies histologically. Two cases were clinically unsuspected. Factors that had a significant relationship with complete hydatidiform mole included maternal age of 35 years and above (aOR 13.5; CI: 1.46–125.31; p=0.00), gestational age beyond the first trimester at the time of uterine evacuation (aOR 6.2; CI: 1.07–36.14; p=0.04), and history of previous abortion (aOR 4.3; CI: 1.00–18.57; p=0.05). Conclusion. The prevalence of complete hydatidiform mole was high at 6.1%. Associated risk factors included advanced maternal age (35 years and above), history of previous abortions, and gestational age beyond the first trimester at the time of evacuations. Recommendations. We recommend putting in place capacity to do routine histopathological examination of all products of conception especially those at high risk for a molar gestation either by clinical suspicion or by risk factors including advanced maternal age, advanced gestational age, and history of previous abortion because of high prevalence of complete mole.

Download Full-text

Spontaneous Miscarriage in Women Having More Than Three Miscarriages and Advanced Maternal Age

10.53350/pjmhs211582172 ◽

2021 ◽

Vol 15 (8) ◽

pp. 2172-2174

Author(s):

Hina Zubair ◽

Amber-u-Nissa Soomro ◽

Shafqat Mukhtar ◽

Aurooj Fatima

Keyword(s):

Pregnant Women ◽

Maternal Age ◽

Clinical History ◽

Advanced Maternal Age ◽

First Trimester ◽

Age Group ◽

Recurrent Miscarriages ◽

Spontaneous Miscarriage ◽

History Of ◽

Azad Kashmir

Background: Miscarriages are negative outcomes of a pregnancy. Their ratio increases in women with recurrent miscarriages. Objective: To identify the role of age and recurrent miscarriages in spontaneous abortions. Study Design: Comparative analytical study Place and Duration of Study: Department of Obstetrics & Gynecology, Mohtarma Benazir Bhutto Medical College Mir Pur, Azad Kashmir from 1st October 2020 to 31st March 2021. Methodology: One hundred and twenty pregnant women between the age group of 19-40 years. The clinical history of recurrent miscarriages and demography was noted. Results: The mean age was 29.85±4.71 years with 42% of previous miscarriage occurred in pregnant women at their first trimester. The highest number of recurrent miscarriages (>4) was noted in 36-40 years of age group. Conclusion: The rate spontaneous miscarriages increases with increasing age and recurrent history of miscarriages Key words: Spontaneous miscarriage, Advanced maternal age, Recurrent

Download Full-text

Evaluation of Pregnancy Outcomes at Advanced Maternal Age

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.587 ◽

2019 ◽

Vol 7 (12) ◽

pp. 1951-1956 ◽

Cited By ~ 1

Author(s):

Małgorzata Radoń-Pokracka ◽

Beata Adrianowicz ◽

Magdalena Płonka ◽

Paulina Danił ◽

Magdalena Nowak ◽

...

Keyword(s):

Caesarean Section ◽

Gestational Age ◽

Maternal Age ◽

Statistical Significance ◽

Advanced Maternal Age ◽

Neonatal Outcomes ◽

University Hospital ◽

Large For Gestational Age ◽

Predisposing Factor ◽

Over 40 Years

AIM: The study aimed to investigate the association between advanced maternal age (AMA) and the risk of adverse maternal, perinatal and neonatal outcomes about parity in singleton pregnancies.METHODS: We retrospectively analysed 950 women who gave birth in the Department of Obstetrics and Perinatology of the University Hospital in Kraków for six months (between 1st January and 30th June 2018). The patients were divided into 3 groups according to their age (30-34 years old, 35-39 years old and over 40 years old). Each of these groups was subsequently subdivided into 2 groups depending on parity (primiparae and multiparae). Maternal, perinatal and neonatal outcomes were compared between the groups and the subgroups.RESULTS: Comparison of the three age groups revealed that advanced maternal age might constitute a predisposing factor for preterm birth, caesarean section and large for gestational age (LGA). From these parameters, statistical significance was reached in case of greater risk of LGA (OR = 2.17), caesarean section (OR = 2.03) and elective C-section (OR = 1.84) in women over 40 years old when compared to the patients aged 30-34. Furthermore, AMA increases the risk of postpartum haemorrhage (OR = 6.43). Additionally, there is a negative correlation between maternal age and gestational age at delivery (R = -0.106, p < 0.05).CONCLUSIONS: Advanced maternal age can undoubtedly be associated with several adverse perinatal outcomes. At the same time, the risk of perinatal complications begins to increase after the age of 35 but becomes significant in women aged ≥ 40.

Download Full-text

Hydatidiform Moles: Ancillary Techniques to Refine Diagnosis

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2018-0226-ra ◽

2018 ◽

Vol 142 (12) ◽

pp. 1485-1502 ◽

Cited By ~ 15

Author(s):

Brigitte M. Ronnett

Keyword(s):

Interobserver Variability ◽

Hydatidiform Mole ◽

Immunohistochemical Analysis ◽

Gestational Trophoblastic Disease ◽

Complete Hydatidiform Mole ◽

Algorithmic Approach ◽

Genetic Features ◽

Polymerase Chain ◽

Dna Genotyping ◽

Hydatidiform Moles

Context.— Distinction of hydatidiform moles from nonmolar specimens and subclassification of hydatidiform moles as complete hydatidiform mole versus partial hydatidiform mole are important for clinical practice and investigational studies. Risk of persistent gestational trophoblastic disease and clinical management differ for these entities. Diagnosis based on morphology is subject to interobserver variability and remains problematic, even for experienced gynecologic pathologists. Objectives.— To explain how ancillary techniques target the unique genetic features of hydatidiform moles to establish diagnostic truth, highlight the issue of diagnostic reproducibility and importance of diagnostic accuracy, and illustrate use of p57 immunohistochemistry and polymerase chain reaction–based DNA genotyping for diagnosis. Data Sources.— Sources are the author's 10-year experience using ancillary techniques for the evaluation of potentially molar specimens in a large gynecologic pathology practice and the literature. Conclusions.— The unique genetics of complete hydatidiform moles (purely androgenetic), partial hydatidiform moles (diandric triploid), and nonmolar specimens (biparental, with allelic balance) allow for certain techniques, including immunohistochemical analysis of p57 expression (a paternally imprinted, maternally expressed gene) and genotyping, to refine diagnoses of hydatidiform moles. Although p57 immunostaining alone can identify complete hydatidiform moles, which lack p57 expression because of a lack of maternal DNA, this analysis does not distinguish partial hydatidiform moles from nonmolar specimens because both express p57 because of the presence of maternal DNA. Genotyping, which compares villous and decidual DNA patterns to determine the parental source and ratios of polymorphic alleles, distinguishes purely androgenetic complete hydatidiform moles from diandric triploid partial hydatidiform moles, and both of these from biparental nonmolar specimens. An algorithmic approach to diagnosis using these techniques is advocated.

Download Full-text

A Case of Invasive Mole

Faridpur Medical College Journal ◽

10.3329/fmcj.v12i2.34236 ◽

2017 ◽

Vol 12 (2) ◽

pp. 86-87

Author(s):

Shahana Ahmed ◽

Dipti Rani Shaha

Keyword(s):

Hydatidiform Mole ◽

The Body ◽

Emergency Laparotomy ◽

Molar Pregnancy ◽

Complete Hydatidiform Mole ◽

Partial Hydatidiform Mole ◽

Normal Limits ◽

History Of ◽

Invasive Mole

Invasive mole is a condition where a molar pregnancy, such as a partial hydatidiform mole or complete hydatidiform mole, invades the wall of the uterus, potentially spreading and metastasizing to other parts of the body. Here is a case who presented with history of evacuation for molar pregnancy. She presented with irregular P/V bleeding on and off and after admission silent perforation with massive haemoperitoneum was detected for which emergency laparotomy was done. She recovered and was followed up till her b-hCG levels were within normal limits. As patient presented to us with haemoperitoneum and on laparotomy, there was invasion into whole of the uterus, it could not be saved and hysterectomy was done.Faridpur Med. Coll. J. Jul 2017;12(2): 86-87

Download Full-text

Pemphigoid Gestationis after Spontaneous Expulsion of a Massive Complete Hydatidiform Mole

Case Reports in Obstetrics and Gynecology ◽

10.1155/2013/267268 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Naoki Matsumoto ◽

Marie Osada ◽

Kou Kaneko ◽

Ken Ohara ◽

Daito Noguchi ◽

...

Keyword(s):

Hydatidiform Mole ◽

Vital Signs ◽

Oral Prednisolone ◽

Skin Lesions ◽

Complement C3 ◽

Entire Body ◽

Complete Hydatidiform Mole ◽

Pemphigoid Gestationis ◽

Spontaneous Expulsion ◽

Hydatidiform Moles

Pemphigoid gestationis (PG) is a rare, perinatal, autoimmune, and blistering dermatosis. Only few cases of PG involving hydatidiform moles have been reported. Complete hydatidiform moles are usually evacuated by dilatation and curettage. We report a patient with a massive complete hydatidiform mole that underwent spontaneous expulsion; she subsequently developed PG. A 19-year-old unmarried nulligravid woman was referred to our hospital following excessive vaginal bleeding after an uncertain amenorrheal period. The patient presented with preshock vital signs, severe anemia, and a positive urine pregnancy test. Imaging examinations revealed a massive intrauterine mass (19 × 15 × 10 cm), suggesting a complete hydatidiform mole. She was hospitalized and treated with blood transfusion. Sixteen hours after hospitalization, the massive molar mass underwent spontaneous expulsion and bleeding ceased. Three days after the expulsion, she developed pruritic skin lesions including papules, erythemas, and bullae, which spread over her entire body. Skin biopsy revealed PG and subepidermal blister formation and linear complement C3 deposition along the basement membrane zone, and the serum anti-BP180 antibody level was found to be high on measurement. She was effectively treated with 50 mg/day of oral prednisolone. Her skin lesions disappeared, leaving pigmentation.

Download Full-text

Maternal Risk Factors of Placenta Praevia and Its Effects on Maternal and Fetal Outcome

Bangladesh Medical Journal ◽

10.3329/bmj.v48i2.51259 ◽

2019 ◽

Vol 48 (2) ◽

pp. 7-12

Author(s):

Alpana Adhikary ◽

Anwara Begum ◽

Fahmida Sharmin Joty ◽

Nihar Ranjan Sarker ◽

Rifat Sultana

Keyword(s):

Risk Factors ◽

Maternal Age ◽

Advanced Maternal Age ◽

Fetal Outcome ◽

Placenta Praevia ◽

Maternal Risk Factors ◽

High Parity ◽

Maternal Risk ◽

Antepartum Haemorrhage ◽

History Of

Placenta praevia is one of the most serious obstetric emergencies, which continues to be an important contributor to perinatal mortality and is responsible for leading maternal and infant morbidity. Very few data on etiology of placenta praevia are available till now. This study aims to explore the maternal risk factors related to occurrence of placenta praevia and its effects on maternal and fetal outcome. This cross-sectional observational study was carried out among 3279 obstetrics patients admitted in labour ward in the Department of Obstetrics and Gynecology, Sher-e-Bangla Medical College Hospital from January to December 2006. Out of 3279 obstetrics patients 93 placenta praevia cases were identified purposively as study subjects. The patients of placenta praevia were selected either diagnosed clinically by painless antepartum haemorrhage or asymptomatic placenta praevia diagnosed by ultrasonography irrespective of age, gestational age, parity, booking status. Pregnant woman admitted with painful antepartum haemorrhage were excluded from the study. With the ethical approval from the Institutional Ethical Committee (IEC), patients were selected after taking their written consent. A structured questionnaire and a chick list were designed with considering all the variables of interest. Out of 93 respondents, 73.88% were associated with risk factors in addition to advanced maternal age and high parity. Among them 24.73%, 33.33% and 7.52% had history of previous caesarean section (CS), MR and abortion and both CS & abortion previously. Patients aged above 30 years were 47% and 35.48% were in their 5th gravid and more; whereas, 31.18% patients were asymptomatic, 68.82% patients presented with varying degree of vaginal bleeding, among them 12.08% were in shock. Active management at presentation was done on 76.34% patients and 23.66% were managed expectantly. CS was done o 82.79% patients and only 17.2% were delivered vaginally. Case fatality rate was 1.07% and about 22% perinatal death was recorded, majority belonged to low birth weight (<1500 gm). About 10% patients required caesarean hysterectomy, 3.22% required bladder repair. Advanced maternal age, high parity, history of previous CS and abortion found to be common with the subsequent development of placenta praevia. Proper diagnosis, early referral and expectant management of patients will reduce prematurity, thereby improvised foetal outcome but to improve maternal outcome rate of primary CS have to be reduced and increase practice of contraception among women of reproductive age. Bangladesh Med J. 2019 May; 48 (2): 7-12

Download Full-text

Successful Primary Treatment of a Hydatidiform Mole with Methotrexate and EMA/CO

Case Reports in Medicine ◽

10.1155/2009/454161 ◽

2009 ◽

Vol 2009 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

M. De Vos ◽

M. Leunen ◽

C. Fontaine ◽

Ph. De Sutter

Keyword(s):

Surgical Treatment ◽

Complete Remission ◽

Treatment Option ◽

Hydatidiform Mole ◽

Uterine Fibroids ◽

Treatment Method ◽

Primary Treatment ◽

Molar Pregnancy ◽

Complete Hydatidiform Mole ◽

Hydatidiform Moles

Background. The preferred treatment method of most hydatidiform moles is suction aspiration. In rare circumstances uterine abnormalities may preclude surgical treatment.Case. We report a case of complete molar pregnancy successfully treated with methotrexate followed by EMA/CO. A 38-year-old woman with a complete hydatidiform mole and multiple uterine fibroids underwent a failed attempt at suction aspiration. Following treatment with methotrexate, a nonmetastatic persistent trophoblastic tumour developed. Six cycles of EMA/CO led to complete remission.Conclusion. We propose that primary treatment of molar pregnancies with chemotherapy is a useful treatment option in cases where uterine abnormalities interfere with suction aspiration.

Download Full-text

CONSANGUINITY AND MATERNAL AGE;

The Professional Medical Journal ◽

10.29309/tpmj/2017.24.04.1458 ◽

2017 ◽

Vol 24 (04) ◽

pp. 511-515

Author(s):

Nayyab Zehra ◽

Ahmed Hassaan Malik ◽

Zahabia Khalid ◽

Misha Sabir ◽

Simra Tanvir ◽

...

Keyword(s):

Family History ◽

Gestational Age ◽

Maternal Age ◽

Sampling Technique ◽

Reproductive Age ◽

Military Hospital ◽

Age Group ◽

Spontaneous Abortions ◽

Cross Sectional ◽

History Of

Objectives: To determine the frequency of risk factors i.e. consanguinity andmaternal age associated with spontaneous abortions in Pakistan and to propose ways toreduce them. Study design: Cross sectional descriptive study. Place of study: Gynecologydepartment of Military Hospital and Combined Military Hospital, Rawalpindi. Duration ofstudy: 6 months (September 2015 to February 2016). Sampling technique: Non probabilityconvenient sampling. Methodology: 150 married female patients in reproductive age group(15-49 years), who were confirmed cases of pregnancy and presented with abortions, wereinterviewed and responses were filled in a structured questionnaire after written consent.The collected data was then entered and analyzed by SPSS 20.0. Results: The major bulkof spontaneous abortions occurred in the maternal age group of 25-35 years (55.3%). A totalof 53.3% of abortions occurred in the gestational age of less than 12 weeks. Around 54.7% offemales had family history of spontaneous abortions and 65.3% had consanguineous marriage.Conclusion: Spontaneous abortions occur more frequently in the females of 25-35 yearsage group and among the fetuses with gestational age less than 12 weeks (1st trimester ofpregnancy). Family history of spontaneous abortions and consanguinity are associated withspontaneous abortions.

Download Full-text