Changing presentation of complete hydatidiform mole at the New England Trophoblastic Disease Center over the past three decades: Does early diagnosis alter risk for gestational trophoblastic neoplasia?

Sun, Sue Yazaki; Melamed, Alexander; Goldstein, Donald P.; Bernstein, Marilyn R.; Horowitz, Neil S.; Moron, Antônio Fernandes; Maestá, Izildinha; Braga, Antônio; Berkowitz, Ross S.

doi:10.1016/j.ygyno.2015.05.002

Cited by 71 publications

(77 citation statements)

References 10 publications

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“…This was attributed to the implementation of early routine ultrasound for pregnant women in the region. [7] In contrast, a majority of cases in our study presented with vaginal bleeding. The reason for this may be the labeling of any spotting and brownish vaginal discharge by a patient as vaginal bleeding.…”

Section: Discussioncontrasting

confidence: 56%

“…[5] Low dietary carotene and animal fat consumption is associated with increased risk of molar pregnancy. [67] Two reports from Saudi Arabia in 1988, reported incidence of molar pregnancy 1:446 and 1:676 pregnancies;[89] whereas, a study in 2003 reported incidence as 0.9 per 1000 pregnancies. [10] This decrease in incidence may be related to an improvement in socioeconomic and dietary factors as animal studies have shown that diet can reset genetic outline.…”

Section: Introductionmentioning

confidence: 99%

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Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a Tertiary Care Hospital in Dammam, Saudi Arabia

Al-Talib¹

2016

J Fam Community Med

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Objectives:To study the clinical presentation and treatment outcome of molar pregnancy at a Tertiary Care Hospital in Dammam, Saudi Arabia.Materials and Methods:Reviewed medical records of all molar pregnancy cases among all the deliveries at a tertiary care hospital in Dammam from 2005 to 2014, after approval by institutional ethical review committee. Data abstracted included patient's age, parity, presenting symptoms, gestational age at diagnosis, uterine size, ultrasonographic findings, BhCG level at the time of diagnosis and at follow-up after evacuation, and blood loss during evacuation. Data was entered and analyzed using Excel; frequency distribution for categorical variables and descriptive statistics for continuous variables were computed.Results:Of a total of 25,000 deliveries in ten years, 22 cases of complete molar pregnancy were encountered: 0.9 cases of molar pregnancy per 1000 pregnancies. Majority of patients (63.7%) were older than 35 years, and were nulliparous (45.5%). The commonest symptom was vaginal bleeding (86.4%) followed by hyperemesis gravidarum (41.0%); Hyperthyroidism was seen in 1 patient (4.5%). Ovarian enlargement by theca-lutin cyst was seen in 3 patients (13.6%). The majority of patients (63.6%) had normal BhCG within 9 weeks (63 days) after suction curettage. The majority of the cases followed a benign course.Conclusion:Aged older than 35 years seems a risk factor and vaginal bleeding is the commonest presenting symptom. Early booking of pregnant women to antenatal care clinics and routine first trimester ultrasound made diagnosis easier and earlier before complications appear.

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Section: Discussioncontrasting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a Tertiary Care Hospital in Dammam, Saudi Arabia

Al-Talib¹

2016

J Fam Community Med

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“…An excessive uterine size was considered present if the uterus was at least 4 weeks greater in size than expected for the gestational age on clinical examination 14,15. Theca lutein ovarian cysts >6 cm were identified by pelvic ultrasound and by bimanual pelvic examination performed under anesthesia prior to uterine evacuation 14.…”

Section: Methodsmentioning

confidence: 99%

Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study

Asmar¹,

Braga²,

Filho³

et al. 2017

Clinics

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OBJECTIVES:Doppler ultrasonography can be used to assess neoangiogenesis, a characteristic feature of postmolar gestational trophoblastic neoplasia. However, there is limited information on whether uterine artery Doppler flow velocimetry parameters can predict gestational trophoblastic neoplasia following a complete hydatidiform mole. The purpose of this study was as follows: 1) to compare uterine blood flow before and after complete mole evacuation between women who developed postmolar gestational trophoblastic neoplasia and those who achieved spontaneous remission, 2) to assess the usefulness of uterine Doppler parameters as predictors of postmolar gestational trophoblastic neoplasia and to determine the best parameters and cutoff values for predicting postmolar gestational trophoblastic neoplasia.METHODS:This prospective cohort study included 246 patients with a complete mole who were treated at three different trophoblastic diseases centers between 2013 and 2014. The pulsatility index, resistivity index, and systolic/diastolic ratio were measured by Doppler flow velocimetry before and 4-6 weeks after molar evacuation. Statistical analysis was performed using Wilcoxon’s test, logistic regression, and ROC analysis.RESULTS:No differences in pre- and post-evacuation Doppler measurements were observed in patients who developed postmolar gestational trophoblastic neoplasia. In those with spontaneous remission, the pulsatility index and systolic/diastolic ratio were increased after evacuation. The pre- and post-evacuation pulsatility indices were significantly lower in patients with gestational trophoblastic neoplasia (odds ratio of 13.9-30.5). A pre-evacuation pulsatility index ≤1.38 (77% sensitivity and 82% specificity) and post-evacuation pulsatility index ≤1.77 (79% sensitivity and 86% specificity) were significantly predictive of gestational trophoblastic neoplasia.CONCLUSIONS:Uterine Doppler flow velocimetry measurements, particularly pre- and post-molar evacuation pulsatility indices, can be useful for predicting postmolar gestational trophoblastic neoplasia.

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“…Recent developments in obstetrical practice and pathologic diagnosis have the potential to increase detection of HM and have altered the incidence of HM. The routine use of obstetrical ultrasonography in the first trimester of pregnancy has led to early and accurate detection of pregnancy loss and earlier detection of HM, often at an asymptomatic stage, 6 albeit with both high false-positive and false-negative detection rates for HM. 7 Abnormal ultrasonographic placental findings suspicious for HM can alert the pathologist to undertake a more thorough and detailed pathologic examination of spontaneous and missed abortion specimensVpossibly leading to increased detection of HM.…”

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confidence: 99%

A Reappraisal of the Incidence of Placental Hydatidiform Mole Using Selective Molecular Genotyping

Colgan

Chang

Nanji

et al. 2016

Int J Gynecol Cancer

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Changing presentation of complete hydatidiform mole at the New England Trophoblastic Disease Center over the past three decades: Does early diagnosis alter risk for gestational trophoblastic neoplasia?

Cited by 71 publications

References 10 publications

Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a Tertiary Care Hospital in Dammam, Saudi Arabia

Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a Tertiary Care Hospital in Dammam, Saudi Arabia

Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study

A Reappraisal of the Incidence of Placental Hydatidiform Mole Using Selective Molecular Genotyping

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