Cervical Hydatidiform Moles Pregnancy: Diagnosis and Treatment

Cervical partial hydatidiform mole is a rare condition and difficult to diagnose. A 39-year-old Balinese woman from Sanglah General Hospital, Bali, Indonesia complained vaginal bleeding with abdominal pain. The patient was diagnosed with a partial hydatidiform mole based on physical examination, ultrasound, beta HCG levels and pathology examinations. Mass evacuation surgery followed by arterial ligation to stop the bleeding and periodically examination of beta HCG levels was carried out until the 14th week after the procedure. Beta HCG decreased gradually to normal level and indicate no risk of trophoblastic malignancy. Establishing the early diagnosis significantly affects the outcome of patient. Keywords: partial cervical hydatidiform mole, blighted ovum, pregnancy, diagnosis, therapy.

The Contribution of QF-PCR and Pathology Studies in the Diagnosis of Diandric Triploidy/Partial Mole

Objective: the aim of our study was to assess the contribution of quantitative fluorescent polymerase chain reaction (QF-PCR) and pathology studies in the diagnosis of diandric triploidies/partial hydatidiform moles. Methods: this study included all fet al triploidies diagnosed by QF-PCR in chorionic villi or amniotic fluid in the 2 centers of BCNatal in which a maternal saliva sample was used to establish its parental origin. Pathology studies were performed in products of conception and concordance between a partial hydatidiform mole diagnosis and the finding of a diandric triploidy was assessed. Results: among 46 fetal triploidies, found in 13 ongoing pregnancies and in 33 miscarriages, there were 26 (56%) diandric triploidies. Concordant molecular (diandric triploidy) and pathology results (partial mole) were achieved in 14 cases (54%), while in 6 cases (23%) pathology studies were normal, and in the remaining 6 cases (23%) pathology studies could not be performed because miscarriage was managed medically. Conclusions: diandric triploidy is associated with partial hydatidiform mole and its diagnosis is crucial to prevent the development of persistent trophoblastic disease. QF-PCR analysis in chorionic villi or amniotic fluid provides a more accurate diagnosis of the parental origin of triploidy than the classical pathology studies.

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

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.

Medical termination of a partial hydatidiform mole with coexisting fetus during second trimester; management dilemma: a case report

Partial hydatidiform mole and coexisting foetus is a rare condition, with an incidence of 122,000-1,000,000 pregnancies. It presents a dilemma for obstetricians when detected in second trimester of pregnancy. Medical termination is effective during second trimester; however, it increases the risk of occurrence of persistent trophoblastic disease. Following a review of literature, it was seen that most of the PHMCF terminated by medical induction during second trimester resulted in the development of PTD and lung metastasis. However, cases terminated by caesarean section during the third trimester did not develop PTD or metastasis. A 34 year old woman, gravida 3 para 2 at 25 weeks and 3 days of gestation, presented with absent fetal movements. She was markedly pale. She had no prior antenatal visits. Ultrasound examination revealed a single intrauterine foetus at 23 weeks of gestation with no cardiac activity. Spalding sign was positive. Liquor was reduced and showed internal echoes, secondary to intramniotic bleed. Placenta was grossly enlarged, anterior in location with multiple cystic areas suggestive of a partial mole. As her haemoglobin was 5.6 grams, she was transfused with 3 units of packed cells. The patient underwent induced medical abortion after counselling for risk of persistent trophoblastic disease and long term follow up. She was followed up with weekly serial serum beta hCG monitoring, which returned to normal within a month. She showed no signs of persistent trophoblastic disease at 3 months follow up and has been advised to continue follow up for a year. Mid-trimester termination of pregnancy due to PHMCF is challenging due to high risk of PTD and metastasis associated with it. Performance of caesarean section is not recommended during second trimester of pregnancy but is a relatively safer strategy to avoid the risks of persistent trophoblastic disease.