scholarly journals Management of Partial Hydatidiform Mole and Subsequent Intrauterine Adhesions: A Case Report and Literature Review

2020 ◽  
Vol 11 (4) ◽  
pp. 6
Author(s):  
Dor Partosh ◽  
Genevieve Hale
Keyword(s):  
Live Birth ◽  
Adjuvant Treatment ◽  
Hormonal Therapy ◽  
Hydatidiform Mole ◽  
Uterine Cavity ◽  
Scar Tissue ◽  
Molar Pregnancy ◽  
Intrauterine Adhesions ◽  
Suction Curettage ◽  
Uterine Polyps

Background: Gestational trophoblastic disease (GTD) originates from placental tissue and is among rare human tumors that can be cured even in the presence of widespread metastases. The most common form of GTD is hydatidiform mole (HM), commonly referred to as molar pregnancy. Molar pregnancies have the potential to locally invade the uterus and metastasize and result as a result of gestational trophoblastic neoplasia. Intrauterine adhesions (IUAs) is a condition where scar tissue develops within the uterine cavity, often following a procedure. Hysteroscopy has been established as the criterion standard for the diagnosis of IUAs, although the optimal adjuvant treatment after surgical intervention remains unclear. ‎ Case: A 35-year-old-female underwent suction curettage a week after the detection of a molar pregnancy. Two months later, she suffered from amenorrhea and hormonal therapy was initiated. Saline-infusion sonogram was tried and failed due to cervical stenosis. IUAs leading to scar tissue developed along with uterine polyps. Hysteroscopy successfully lysed IUAs and uterine polyps. The patient conceived two months after stopping hormonal therapy and proceeded to a pregnancy which resulted in a healthy live birth. Conclusion: Although the etiology of the patient’s molar pregnancy is still unknown, this report demonstrates the need to utilize hysteroscopy as a primary and early mode of treatment if IUAs are found in patients along with providing adjuvant treatment while utilizing clinical judgement in order to prevent IUAs recurrence. The patient conceived four months after the hysteroscopy resulting in a healthy live birth.    Article Type: Clinical Experience

scholarly journals Laparoscopic hysterectomy as a treatment modality for gestational trophoblastic neoplasia - report of two cases

2021 ◽  
pp. 82-82
Author(s):  
Predrag Jokanovic ◽  
Aleksandar Rakic
Keyword(s):  
Hydatidiform Mole ◽  
Uterine Cavity ◽  
Laparoscopic Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Molar Pregnancy ◽  
Placental Site Trophoblastic Tumor ◽  
Variable Intensity ◽  
Partial Hydatidiform Mole ◽  
Trophoblastic Tumor ◽  
Placental Site

Introduction. Measurement of the serum levels of human chorionic gonadotropin?s beta isoform (bhCG) remains a crucial marker for diagnosing the GTN. Choriocarcinoma is commonly diagnosed due to extremely high levels of bhCG, but the presence of distant metastasis is not uncommon. Placental site trophoblastic tumor and epithelioid trophoblastic tumor remain some sort of an enigma because the levels of bhCG are usually low. Case report. A 44-year old patient, P2G3,was admitted to the Clinic under the suspicion of molar pregnancy, vaginal bleeding with variable intensity, and levels of bhCG of 1 837 787 mIU/mL. After two explorative curettages, bhCG saw a decline and a partial hydatidiform mole was diagnosed histopathologically. The patient was admitted to the Clinic on two occasions due to the increasing values of bhCG. Since bhCG failed to drop after two explorative curettages, hysteroscopic biopsy, one chemotherapy cycle, along with the suspicious ultrasonographic feature of metastatic GTN and the fact that the patient has refused further chemotherapy, a total laparoscopic hysterectomy was performed. Histopathological exam made the diagnosis of choriocarcinoma. A 50-year old patient, P2G4, was admitted to the Clinic under the ultrasonographic suspicion of molar pregnancy. She was complaining of pelvic discomfort and frequent urination. Initial levels of bhCG were 128 351 mIU/mL. Instrumental revision of the uterine cavity was performed and partial hydatidiform mole was diagnosed histopathologically. Because of the increasing levels of bhCG, ultrasonographical suspicion of the development of GTN in the uterine corpus, in accordance with patient?s age and the fact that she has regular menstrual cycles, total laparoscopic hysterectomy was performed, and a histopathological exam made the diagnosis of the placental site trophoblastic tumor. Conclusion. Laparoscopic hysterectomy could be a treatment of choice for the chemotherapy resistant GTNs but also for the choricarcinoma in patitent?s who have finished their reproductive activity and refuse to be treated with chemotherapeutics.

scholarly journals Management of twin pregnancy with a hydatidiform mole and surviving healthy co-existent fetus

2017 ◽  
Vol 6 (12) ◽  
pp. 5636
Author(s):  
Hale Goksever Celik ◽  
Gözde Meriç Demirezen ◽  
Baki Erdem ◽  
Alev Atış Aydın ◽  
Volkan Ülker
Keyword(s):  
Maternal Morbidity ◽  
Twin Pregnancy ◽  
Hydatidiform Mole ◽  
Uterine Cavity ◽  
First Trimester ◽  
Molar Pregnancy ◽  
Complete Mole ◽  
Live Fetus ◽  
Twin Pregnancies ◽  
Normal Placenta

Twin pregnancies with complete mole and a coexisting live fetus are rare obstetric conditions seen in 1 case of 22000 to 100000 pregnancies. In our case, a twin molar pregnancy was diagnosed in the first trimester by ultrasound. In a 27-year-old patient with the first pregnancy, a 12-week live fetus with a normal placenta and a twin molar pregnancy appearance were observed on a routine ultrasonographic examination of the uterine cavity. Twin molar pregnancies are reported to be terminated by live birth in the literature, but termination of pregnancy is an important option to prevent maternal morbidity since molar pregnancy may lead to complications ranging from theca lutein cysts to gestational trophoblastic neoplasia.

Gestational trophoblastic syndrome: An audit of 112 patients. A South African experience

2003 ◽  
Vol 13 (2) ◽  
pp. 234-239 ◽  
Author(s):  
M. Moodley ◽  
K. Tunkyi ◽  
J. Moodley
Keyword(s):  
South Africa ◽  
Hydatidiform Mole ◽  
Previous History ◽  
Spontaneous Remission ◽  
Molar Pregnancy ◽  
Complete Cure ◽  
Trophoblastic Disease ◽  
Retrospective Audit ◽  
Suction Curettage ◽  
Clinical Records

Gestational trophoblastic disease (GTD) represents a spectrum of histologically distinct entities including molar pregnancy and choriocarcinoma. The incidence of GTD varies in different parts of the world with high incidences in countries like Japan (2/1000 pregnancies). With the advent of sensitive assays for detection of serum β human chorionic gonadotrophin (HCG) and ultrasound, GTD can now be detected earlier in pregnancy. To date no studies have been reported from South Africa regarding the epidemiology, management, and outcome of patients with GTD. This study was a retrospective audit based on 112 patients with GTD treated at King Edward VIII Hospital, Durban, South Africa. Clinical records of patients were reviewed with regards to presentation, investigation, management and outcome. Of 112 patients, there were 78 patients (70%) with hydatidiform mole and 34 patients (30%) with choriocarcinoma. The mean age of patients was 28.5 years (SD 8.1 years). The majority of patients were Black females (94.6%) while 4.4% were Asian and 1% Coloured females. The most common presenting symptom was vaginal bleeding (93.8%). There were 74 patients (66.7%) who had a previous normal term pregnancy and only two patients (1.8%) had previous molar pregnancies. Suction curettage was the main treatment modality for patients with molar pregnancy while choriocarcinoma was treated primarily with chemotherapy. A total of 72 percent of patients with molar pregnancy and 28 percent with choriocarcinoma had complete remission after initial treatment. Twelve patients died during the course of treatment mainly due to late presentation and advanced metastatic disease. Complete cure was achieved in 89% of patients. Age, parity, previous history, initial uterine size, presence of theca-lutein cysts, and initial βHCG concentration was not found to be prognostic for persistent trophoblastic disease. In the present study, the incidence of molar pregnancy and choriocarcinoma was 1.2/1000 and 0.5/1000 deliveries, respectively. This is much lower than those quoted from countries such as Japan. However, the incidence quoted from our study may be overestimated as this was a hospital-based study and most of the uncomplicated deliveries occur in referring centers. Only 20% of patients in this study were above the age of 35 years with a mean age of 28.5 years. The majority of patients were of Black African ethnic origin mainly due to the fact that our hospital is a referral center for Black patients. Similar to other studies, the majority of patients with molar pregnancy were treated with suction curettage while the majority of patients with choriocarcinoma were treated with chemotherapy. Overall, spontaneous remission was achieved in 60% of patients with molar pregnancy and an overall complete cure was achieved in 89% of patients.

Molar Pregnancy in Cesarean Section Scar: A Case Report and Literature Review

2020 ◽  
Author(s):  
Mine Daggez ◽  
Mehmet Dolanbay
Keyword(s):  
Ultrasound Guidance ◽  
Case Reports ◽  
Hydatidiform Mole ◽  
Rare Condition ◽  
Molar Pregnancy ◽  
Resonance Imaging ◽  
Cesarean Scar Pregnancy ◽  
Cesarean Scar ◽  
Suction Curettage ◽  
Magnetic Resonance Imaging Mri

AbstractMolar pregnancy in cesarean scar is an extremely rare condition. It has a high risk of uterine rupture and bleeding. There is a small number of case reports in the literature, so the optimal diagnostic algorithms and management are not clear. We reported a 25-year-old woman who presented to our clinic with amenorrhea for 40 days and vaginal bleeding for 3 days. Transvaginal ultrasonography and serum human chorionic gonadotropin (hCG) level raised suspicion of a molar cesarean scar pregnancy (CSP). Magnetic resonance imaging (MRI) was conducted for further knowledge of the characteristics of the mass. Careful suction curettage under ultrasound guidance was performed. The histologic examination of the tissue confirmed a partial hydatidiform mole. The differential diagnosis between CSP and molar CSP is extremely challenging. Serum hCG, sonogram, and MRI are our tools, but none of them suffice for a definitive diagnosis. Histological examination of the postoperative sample is still the gold standard for the diagnosis of molar CSP; however, MRI can assist in planning the necessary interventions.

scholarly journals Differential Diagnosis of Amniotic Band and Intrauterine Synechiae in Second Trimester Pregnancy: Case Report

2019 ◽  
pp. 1
Author(s):  
Bekir Kahveci ◽  
Yasemin Dogan ◽  
Gaye Kahveci ◽  
Muhammet Hanifi Bademkiran
Keyword(s):  
Congenital Anomalies ◽  
Uterine Cavity ◽  
Scar Tissue ◽  
Intrauterine Adhesions ◽  
Amniotic Cavity ◽  
Amniotic Band ◽  
Second Trimester Pregnancy ◽  
Band Sequence ◽  
The Right ◽  
Amniotic Band Sequence

<p>Amniotic band sequence (ABS) describes highly variable spectrum of congenital anomalies that occur in association with amniotic bands. İntrauterine synechiae is a condition in which scar tissue develops within the uterine cavity. We aim to present a case of ABS and a case of intrauterine synechiae and compare their ultrasonographic findings. Ultrasonography revealed contraction ring in the right groin area of the first fetus but second fetus was healthy. The diagnosis of ABS is based upon the presence of characteristic structural findings on prenatal ultrasound or postnatal physical examination. The diagnosis of intrauterine adhesions is based upon visualization of intrauterine adhesions either directly by hysteroscopy or indirectly by other imaging studies. The floor of the intrauterine adhesions is widely and lateral of the uterine cavity and occurs from four layers while the amniotic band is a thin layer and forms fluctuations in the amniotic fluid. Amniotic bands may cause variable spectrum of congenital anomalies whereas intrauterine adhesions do not increase the probability of fetal anomaly because it is out of the amniotic cavity.</p>

scholarly journals The Controversy of Hydatidiform Mole Treatment In Women age ≥ 40 year-old

Medicinus ◽  
2018 ◽  
Vol 6 (2) ◽  
Author(s):  
Gabriella Farah ◽  
Julita D.L Nainggolan
Keyword(s):  
Older Patients ◽  
Economic Status ◽  
Hydatidiform Mole ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Gestational Trophoblastic Disease ◽  
Primary Treatment ◽  
Molar Pregnancy ◽  
Recommended Treatment ◽  
Suction Curettage

<p>Background: Hydatidiform mole or commonly known as molar pregnancy is one of the gestational trophoblastic disease (GTD) caused by an abnormal trophoblast proliferation. About 50% of gestational trophoblast neoplasm (GTN) arises from molar pregnancy. Higher risk of GTN was found in older patient, especially women age ≥40 years old. Management of hydatidiform mole is often faced come challenges, especially in developing country like Indonesia. Although, suction curettage is the most recommended treatment for the evacuation of molar pregnancy, hysterectomy is considerable for women who have completed childbirth and do not wish to preserve their fertility.<br />Case: Here we present case of 48 years old women with hydatidiform mole. Considering the age of the patient and the completion of her childbearing, we decided to do a laparotomy total abdominal hysterectomy for the evacuation of the mole instead of suction curettage. Turned out that this patient had an invasive mole, one of the types of gestational trophoblastic neoplasia.<br />Conclusion: Although suction curettage is the most frequent technique for molar evacuation, hysterectomy is a reasonable option as primary treatment to be performed in older patients and for those who do not wish to preserve their fertility. The other important points such as socio-economic status, education level, and geographical issues should be considered also on managing older patients with hydatidiform mole in developing countries</p>

Endometrial Regeneration in Asherman's Syndrome: Clinical and Translational evidence of Stem Cell Therapies

2019 ◽  
Vol 14 (6) ◽  
pp. 454-459
Author(s):  
Xuejing Hou ◽  
Ying Liu ◽  
Isabelle Streuli ◽  
Patrick Dällenbach ◽  
Jean Dubuisson ◽  
...  
Keyword(s):  
Stem Cell ◽  
Molecular Mechanisms ◽  
Uterine Cavity ◽  
Stem Cell Therapies ◽  
Intrauterine Adhesions ◽  
Asherman’S Syndrome ◽  
Cell Therapies ◽  
Fibrotic Process ◽  
Physical Barriers

Asherman’s Syndrome or Intrauterine adhesions is an acquired uterine condition where fibrous scarring forms within the uterine cavity, resulting in reduced menstrual flow, pelvic pain and infertility. Until recently, the molecular mechanisms leading to the formation of fibrosis were poorly understood, and the treatment of Asherman’s syndrome has largely focused on hysteroscopic resection of adhesions, hormonal therapy, and physical barriers. Numerous studies have begun exploring the molecular mechanisms behind the fibrotic process underlying Asherman’s Syndrome as well as the role of stem cells in the regeneration of the endometrium as a treatment modality. The present review offers a summary of available stem cell-based regeneration studies, as well as highlighting current gaps in research.

Normalisation of human chorionic gonadotrophin (hCG) levels in a patient with partial molar pregnancy with a uterine mass without chemotherapy: impact of using herbal remedies

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Norzila Ismail ◽  
Aida Maziha Zainudin ◽  
Gan Siew Hua
Keyword(s):  
Hydatidiform Mole ◽  
Abdominal Ultrasound ◽  
Massive Bleeding ◽  
Chorionic Gonadotrophin ◽  
Human Chorionic Gonadotrophin ◽  
Herbal Remedies ◽  
Lung Field ◽  
Molar Pregnancy ◽  
Brucea Javanica

Abstract Objectives Level of βhCG and the presence of any uterine mass of hydatidiform mole need a careful review or monitoring in order to prevent metastasis, provide an early treatment and avoid unnecessary chemotherapy. Case presentation A 36-year old fifth gravida patient who had a missed abortion was diagnosed as having a molar pregnancy with beta human chorionic gonadotrophin (βhCG) level of 509,921 IU/L. Her lung field was clear and she underwent suction and curettage (S & C) procedure. However, after six weeks, AA presented to the emergency department with a massive bleeding, although her βhCG level had decreased to 65,770 IU/L. A trans-abdominal ultrasound indicated the presence of an intra-uterine mass (3.0 × 4.4 cm). Nevertheless, her βhCG continued to show a declining trend (8,426 IU/L). AA was advised to undergo a chemotherapy but she refused, citing preference for alternative medicine like herbs instead. She opted for an “at own risk” (AOR) discharge with scheduled follow up. Subsequently, her condition improved with her βhCG showing a downward trend. Surprisingly, at six months post S & C, her βhCG ameliorated to 0 IU/L with no mass detected by ultrasound. Conclusions Brucea javanica fruits, Pereskia bleo and Annona muricata leaves can potentially be useful alternatives to chemotherapy and need further studies.

P–575 Patients with recurrent implantation failures (RIF): chromosome abnormalities in the resulting embryos

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
C Albanese ◽  
D Perruzza ◽  
C Tabanelli ◽  
S Sgargi ◽  
M C Magli ◽  
...  
Keyword(s):  
Live Birth ◽  
Uterine Cavity ◽  
Implantation Rate ◽  
Normal Karyotype ◽  
Great Majority ◽  
Chromosome Analysis ◽  
Delivery Rate ◽  
Comparative Genomic ◽  
Male Factor ◽  
Preimplantation Genetic Testing

Abstract Study question Do RIF patients have the preimplantation genetic testing for aneuploidy (PGT-A) overcome their infertility condition? Summary answer PGT-A positively impact on implantation rate in RIF patients What is known already The most common definition of RIF is failure to achieve a pregnancy after three consecutive transfers of good quality embryos. This term possibly represents a heterogeneous category of infertile couples as the causes of repeated failures can be diverse. Especially intriguing is the case of patients with an age lower than 39 years for which the oocyte quality is expected not to be compromised by the well known age effect on female fertility. The chromosome analysis of the resulting embryos has been proposed as a valid method to improve implantation in the great majority of RIF patients Study design, size, duration This retrospective study included 49 patients with at least three previous consecutive implantation failures, which underwent PGT-A from January 2016 to April 2020. Both partners had a normal karyotype. Only patients with a female age below 39 years were included, who presented with a normal uterine cavity. Couples with a severe male factor were excluded. Single frozen blastocysts were transferred according to chromosomal results Participants/materials, setting, methods Maternal age was 35.5 ± 3.1 years. All blastocysts were vitrified after trophectoderm biopsy. Whole genome amplification and array comparative genomic hybridization were performed on biopsies. Only euploid embryos were transferred. The primary outcome was the live-birth delivery rate after the first transfer Main results and the role of chance Before starting a PGT-A cycle, these patients underwent 213 embryo transfers with 251 embryos replaced. A total of 264 blastocysts were analyzed, 140 of which were aneuploid (53%). Monosomy or trisomy was reported in 67 of the diagnosed samples (67/140, 48%) whereas the remaining 73 carried complex aneuploidies (73/140, 52%). The remaining 124 blastocysts (47%) were diagnosed as euploid. All patients performed an embryo transfer resulting in 28 clinical pregnancies (57%). There were 5 spontaneous abortions and the live-birth delivery rate per patient was 47% Limitations, reasons for caution This study suffers from the weakness related to retrospectivity. In addition, as euploid embryos are still cryopreserved, the delivery rate could change at completion of the cycles Wider implications of the findings: A RIF condition can be attributed, at least in a good proportion of cases, to the generation of high percentages of aneuploid embryos. In this case, the transfer of euploid blastocysts has high chances to classify this category of RIF patients has having an embryonic cause of infertilit. Trial registration number Not applicable

scholarly journals A Case of Invasive Mole

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

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