Identification of a hydatidiform mole in twin pregnancy following assisted reproduction

A nomogram to predict preterm birth in twin pregnancies

PURPOSE

To investigate risk factors for preterm birth in twin pregnancies, and to establish a nomogram model for predicting preterm birth and verify its application value.

METHODS

Data from 266 twin pregnancies between January 2015 and December 2020 were analyzed in this retrospective study. According to the gestational weeks of delivery, the included subjects were divided into a preterm birth group (gestational age < 37 weeks) and a full-term group (gestational age ≥ 37 weeks). The general situation and pregnancy complications of the two groups were analyzed by univariate analysis, and the factors with statistical significance were entered into multivariate logistic regression analysis. Furthermore, the nomogram model for predicting the risk of preterm birth was established by using R. The predictive effect of the model was evaluated by the area under the ROC curve, C-index, and decision curve analysis.

RESULTS

Demographic characteristics and their associations with preterm birth and full-term birth in twin pregnancies were summarized and analyzed. After validation, we identified the following significant predictors of preterm birth: chorionic status, inconsistent development of twins, premature rupture of membranes, fetal distress, scar uterus, and preeclampsia. Overall, we constructed preterm risk nomogram model with C-index of 0.783. A nomogram using a 0-100 scale illustrated our final model for predicting preterm birth in twin pregnancies.

CONCLUSIONS

We developed and validated a clinical nomogram to predict preterm birth in twin pregnancy. Chorionic status, inconsistent development of twins, premature rupture of membranes, fetal distress, scar uterus, and preeclampsia were independent risk predictors for preterm birth in twin pregnancy.

Obstetrical and oncological outcomes of twin pregnancies with hydatidiform mole and coexisting fetus

OBJECTIVE

To evaluate the obstetrical and oncological progression of twin pregnancies with hydatidiform mole coexisting fetus (HMCF).

MATERIALS AND METHODS

Using a retrospective method based on patients from the Women's Hospital, Zhejiang University School of Medicine database between January 1990 and October 2020, 17 patients were histologically confirmed as having HMCF, and the patients' prenatal diagnosis, outcomes and development of gestational trophoblastic neoplasia (GTN) were reviewed.

RESULTS

Among these 17 cases, 11 (64.71%) cases were complete hydatidiform mole coexisting fetus (CHMCF), and 6 (35.29%) cases were partial hydatidiform mole coexisting fetus (PHMCF). The gestational age at diagnosis of CHMCF was significantly earlier than that of PHMCF [9 (8-24) vs. 18 (11-32) weeks, respectively, P < 0.05]. The live birth rate of PHMCF was slightly higher than that of CHMCF (33.33%; 18.18%), but this difference was not statistically significant. The overall rate of GTN incidence of HMCF was 47.06% (8/17), and the GTN rates of PHMCF and CHMCF were 33.33% (2/6) and 54.55% (6/11), respectively. There was no significant difference in the GTN rate between patients who chose to continue pregnancy and those who terminated pregnancy before 24 weeks of gestation. The GTN rate of patients with term delivery was not significantly higher than that of preterm delivery.

CONCLUSION

In HMCF cases, the incidence rate of CHMCF was higher than that of PHMCF, and PHMCF is more difficult to diagnose in the early stage. Continuing pregnancy does not increase the risk of GTN compared to terminating pregnancy. In cases of HMCF, when the fetal karyotype is normal and maternal complications are controlled, it is safe to continue the pregnancy and extend it to term.