Persistent Gestational Trophoblastic Disease following Ovarian Molar Pregnancy: A Case report of A Rare Entity with Review of the Literature

Ovarian molar pregnancy, though a very rare entity, behaves like any other molar pregnancy. After surgical management, close follow-up with Beta Human Chorionic Gonadotrophin surveillance is invariable to detect progression to persistent Gestational Trophoblastic Disease, which if develops can be treated successfully with chemotherapy.

ASSOCIATION OF HUMAN CHORIONIC GONADOTROPHIN WITH PREGNANCY INDUCED HYPERTENSION

Objective: To determine the positive predictive value of beta Human Chorionic Gonadotrophin in early secondtrimester for predicting pregnancy induced hypertension. Study Design: Cross-sectional study. Place and Duration of Study: Department of Obstetrics and Gynaecology Combined Military Hospital, Lahore,from Jun 2017 to Nov 2017. Methodology: A total of 214 female pregnant patients met the criteria for inclusion in this study. Patients withbeta human chorionic gonadotrophin (βHcg) levels ≥2 MoM were followed at 22, 26, 30 and 34 weeks of gestation. Blood pressure was monitored. Pregnancy induced hypertension (PIH) was labelled after 20 weeks (as per dating scan) of gestation in patients who did not have proteinuria (≥300 mg 24 hour urine sample) and had a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg (blood pressure readings taken at two separate points in time four hours apart). Results: Patients ranged between 18-35 years of age, with the mean age being 27.3 ± 4.3 years. Mean gestational age was observed to be 15.6 ± 1.8 weeks. Mean BMI was 23.8 ± 3.2 kg/m2. Out of 214 patients, 30 patients (14%) had beta human chorionic gonadotrophin level >2 MoM. Out of these 30 patients, 25 patients (83.3%) developed PIH. There were 100 primigravida (46.7%) and 114 multigravidas (53.3%). Beta human chorionic gonadotrophin in predicting pregnancy induced hypertension showed sensi-tivity of 96.1%, a specificity of 97.3%, with a PPV83.3%, a NPV 99.4% and diagnostic accuracy of 97.2%.

An Incidental Ultrasonographic Diagnosis of Partial Hydatidiform Mole in a Old Primigravida: A Case Report

Hydatidiform mole is an abnormal pregnancy common in Asian populations compared to western countries; however, a partial hydatidiform mole is relatively uncommon and very challenging to diagnose on ultrasound. We reported a 24 years old female visited our clinic whose first antenatal visit was regular with normal viable fetus on ultrasonographic scan. However, an uneventful scan at 12 weeks period of gestation revealed a large irregular gestational sac with the disproportionately small embryo corresponding to 6+6 weeks with no cardiac activity. Additionally, there was markedly thickened placenta measuring 30mm in thickness without cystic spaces within the placenta. Further, her beta-human chorionic gonadotrophin level was very high and suction evacuation sample showed hydropic chorionic villi lined by trophoblastic cells with cistern formation and scalloped border. In conclusion, partial hydatidiform mole is an uncommon molar pregnancy rarely diagnose on ultrasonography. Late first-trimester scan and excessively high beta-human chorionic gonadotrophin levels confirm the diagnosis.