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Altalib A, Al Qahtani N, Alosaimi SS, Al Hashem MS, Almowallad R, Al-Rufiei M, Alhumaid LI. Changing Trends in the Clinical Presentation and Incidence of Molar Pregnancy in Saudi Arabia: A 30-Year Retrospective Analysis. Cureus 2023; 15:e50936. [PMID: 38259393 PMCID: PMC10801279 DOI: 10.7759/cureus.50936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Background Molar pregnancy (MP) incidence and clinical presentation vary significantly worldwide. Recent trends show changes in its clinical representation and incidence, particularly with the adoption of early diagnosis using first-trimester ultrasonography, which has reduced the prevalence of classical second-trimester presentations. This study aimed to analyze the changes in clinical presentation and incidence of MP among the Saudi population over the past 30 years. Methods In this retrospective study at King Fahad University Hospital, 121 complete mole (CM) pregnancy cases diagnosed and pathologically confirmed were reviewed. This included 87 cases from 2007 to 2022 (recent group) and 34 cases from 1992 to 2006 (older group). Cases of CM diagnosed before January 1992 and other diagnoses such as PM, invasive mole, or choriocarcinoma were excluded; thus, this study is focused on CM in particular. We compared patient age, gravidity, parity, abortion history, gestational age at diagnosis, hyperemesis gravidarum symptoms, anemia symptoms, and hemoglobin levels. Classical symptoms and signs related to CM were also reviewed. Data were analyzed using Microsoft Excel 2021 (Microsoft Corporation, Redmond, Washington, United States) and presented as mean, frequency, and percentage, with chi-squared tests for categorical variables; p<0.05 was considered statistically significant. Results The incidence of CM declined from 2.1 per 1,000 deliveries to 0.9 per 1,000 deliveries. Vaginal bleeding was the most common presentation in both the older (91.9%) and recent (67.6%) groups. Hyperemesis gravidarum prevalence was similar in both groups. Theca-lutein cysts were more frequent in the older group (27.5%) than the recent group (8.8%). A significant difference was observed in the occurrence of a large-for-date uterus between the older (63.20%) and recent (23.5%) groups. Notably, 14.7% of patients in the recent group were asymptomatic at diagnosis. Anemia was present in 46 cases (52.8%) of the older group but absent in the recent group, and preeclampsia occurred in 10 cases (11.4%) of the older group but not in the recent group. Conclusions Advancements in ultrasound technology, including transvaginal probes with Doppler capabilities, have enabled earlier pregnancy diagnosis, as early as five to six weeks of gestation. Many MP are now diagnosed in the first trimester without the classic clinical symptoms or "snow-storm" ultrasound appearance. The availability of sensitive beta-human chorionic gonadotropin assays has led to the early termination of these pregnancies, marking a significant shift in the management of MP.
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Affiliation(s)
- Ayman Altalib
- Obstetrics and Gynaecology, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Noura Al Qahtani
- Obstetrics and Gynaecology, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Shrouq S Alosaimi
- Obstetrics and Gynaecology, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Mariam S Al Hashem
- Obstetrics and Gynaecology, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Roaa Almowallad
- Obstetrics and Gynaecology, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Maryam Al-Rufiei
- Obstetrics and Gynaecology, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Lujain I Alhumaid
- Obstetrics and Gynaecology, Imam Abdulrahman Bin Faisal University, Khobar, SAU
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McGregor K, Myat Min A, Karunkonkowit N, Keereechareon S, Tyrosvoutis ME, Tun NW, Rijken MJ, Hoogenboom G, Boel M, Chotivanich K, Nosten F, McGready R. Obstetric ultrasound aids prompt referral of gestational trophoblastic disease in marginalized populations on the Thailand-Myanmar border. Glob Health Action 2018; 10:1296727. [PMID: 28571514 PMCID: PMC5496045 DOI: 10.1080/16549716.2017.1296727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The use of obstetric ultrasound in the diagnosis of gestational trophoblastic disease (GTD) in high-income settings is well established, leading to prompt management and high survival rates. Evidence from low-income settings suggests ultrasound is essential in identifying complicated pregnancies, but with limited studies reviewing specific conditions including GTD. Objective: The aim of this study is to review the role of ultrasound in diagnosis and management of GTD in a marginalized population on the Thailand–Myanmar border. Antenatal ultrasound became available in this rural setting in 2001 and care for women with GTD has been provided by Thailand public hospitals for 20 years. Design: Retrospective record review. Results: The incidence of GTD was 103 of 57,004 pregnancies in Karen and Burmese women on the Thailand–Myanmar border from 1993–2013. This equates to a rate of 1.8 (95% CI 1.5–2.2) per 1000 or 1 in 553 pregnancies. Of the 102 women with known outcomes, one (1.0%) died of haemorrhage at home. The median number of days between first antenatal clinic attendance and referral to hospital was reduced from 20 (IQR 5–35; range 1–155) to 2 (IQR 2–6; range 1–179) days (p = 0.002) after the introduction of ultrasound. The proportion of severe outcomes (death and total abdominal hysterectomy) was 25% (3/12) before ultrasound compared to 8.9% (8/90) with ultrasound (p = 0.119). A recurrence rate of 2.5% (2/80) was observed in the assessable population. The presence of malaria parasites in maternal blood was not associated with GTD. Conclusions: The rate of GTD in pregnancy in this population is comparable to rates previously reported within South-East Asia. Referral time for uterine evacuation was significantly shorter for those women who had an ultrasound. Ultrasound is an effective method to improve diagnosis of GTD in low-income settings and an effort to increase availability in marginalized populations is required.
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Affiliation(s)
- Kathryn McGregor
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Aung Myat Min
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Noaeni Karunkonkowit
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Suporn Keereechareon
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Mary Ellen Tyrosvoutis
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Nay Win Tun
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Marcus J Rijken
- b Julius Centrum Global Health , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Gabie Hoogenboom
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Machteld Boel
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand
| | - Kesinee Chotivanich
- c Mahidol-Oxford Tropical Medicine Research Unit, Department of Tropical Medicine, Faculty of Tropical Medicine , Mahidol University , Bangkok , Thailand
| | - François Nosten
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand.,d Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine , University of Oxford , Oxford , UK
| | - Rose McGready
- a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine , Mahidol University , Mae Sot , Thailand.,d Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine , University of Oxford , Oxford , UK
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Lelic M, Fatusic Z, Iljazovic E, Ramic S, Markovic S, Alicelebic S. Challenges in the Routine Praxis Diagnosis of Hydatidiform Mole: a Tertiary Health Center Experience. Med Arch 2017; 71:256-260. [PMID: 28974845 PMCID: PMC5585792 DOI: 10.5455/medarh.2017.71.256-260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Hydatidiform moles (HM), presenting as complete (CHM) and partial (PHM) form, are rare pregnancy disorder. Diagnosis is based on clinical presentation, ultrasound imaging findings and pathological examination of products of conception. Protein p57, encoded by CKDN1C gene, is paternally imprinted and maternally expressed gene and provides quick insight in genetic basis of HM and allows distinction of CHM from all other conceptions. compare the preevacuational and pathohistological diagnosis with outcome of p57 immunostaining. Material and methods: All cases of HM diagnosed between January 2011 and December 2015 were included in this research. Maternal age, gestational age and input diagnosis data were recored. p57 immunostaining was performed in order to evaluate the diagnosis based on tissue slides examination. Results: There were 198 cases of histologically confirmed HM, 185 PHM, 12 CHM and one case of undefined HM. Mean maternal age in the CHM group was 24,7 and in the PHM group 26,9 years, with no significant differences among these two groups (p=0,27). For CHM mean gestational age was estimated at eight and for PHM 9,2 gestational weeks. Pregnant woman older than 40 years present significant earlier compared with younger woman (p<0,01), and those younger than 20 years tend to present at the beginning of the second trimester more often than older women (p<0,05). In the CHM group, 9 (75%) input diagnoses were mola in obs, and 3 (25%) of them were signed as abortion, unlike the PHM where 126 (67%) were qualified as abortion, 35 (19%) as blighted ovum, and 26 (14%) were suggestive for molar pregnancy. p57 immunostaining results confirmed all pathohistological diagnosis of CHM whereas 8% of PHM demonstrated divergent p57 expression. Conclusion: PHM, compared with CHM, represent a greater diagnostic challenge for both gynecologist and pathologist even when presenting in more advanced pregnancies.
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Affiliation(s)
- Melisa Lelic
- Medical faculty, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zlatan Fatusic
- Clinic for Gynecology and Obstetrics, University Clinical Center of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Ermina Iljazovic
- Department of Pathology, Policlinic for laboratory diagnostic, University Clinical Center of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Suada Ramic
- Medical faculty, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sergije Markovic
- Medical faculty, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Selma Alicelebic
- Institute for Histology and embriology, Medical faculty, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Wang Q, Fu J, Hu L, Fang F, Xie L, Chen H, He F, Wu T, Lawrie TA. Prophylactic chemotherapy for hydatidiform mole to prevent gestational trophoblastic neoplasia. Cochrane Database Syst Rev 2017; 9:CD007289. [PMID: 28892119 PMCID: PMC6483742 DOI: 10.1002/14651858.cd007289.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND This is an update of the original Cochrane Review published in Cochrane Library, Issue 10, 2012.Hydatidiform mole (HM), also called a molar pregnancy, is characterised by an overgrowth of foetal chorionic tissue within the uterus. HMs may be partial (PM) or complete (CM) depending on their gross appearance, histopathology and karyotype. PMs usually have a triploid karyotype, derived from maternal and paternal origins, whereas CMs are diploid and have paternal origins only. Most women with HM can be cured by evacuation of retained products of conception (ERPC) and their fertility preserved. However, in some women the growth persists and develops into gestational trophoblastic neoplasia (GTN), a malignant form of the disease that requires treatment with chemotherapy. CMs have a higher rate of malignant transformation than PMs. It may be possible to reduce the risk of GTN in women with HM by administering prophylactic chemotherapy (P-Chem). However, P-Chem given before or after evacuation of HM to prevent malignant sequelae remains controversial, as the risks and benefits of this practice are unclear. OBJECTIVES To evaluate the effectiveness and safety of P-Chem to prevent GTN in women with a molar pregnancy. To investigate whether any subgroup of women with HM may benefit more from P-Chem than others. SEARCH METHODS For the original review we performed electronic searches in the Cochrane Gynaecological Cancer Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 2, 2012), MEDLINE (1946 to February week 4, 2012) and Embase (1980 to 2012, week 9). We developed the search strategy using free text and MeSH. For this update we searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 5, 2017), MEDLINE (February 2012 to June week 1, 2017) and Embase (February 2012 to 2017, week 23). We also handsearched reference lists of relevant literature to identify additional studies and searched trial registries. SELECTION CRITERIA We included randomised controlled trials (RCTs) of P-Chem for HM. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion in the review and extracted data using a specifically designed data collection form. Meta-analyses were performed by pooling data from individual trials using Review Manager 5 (RevMan 5) software in line with standard methodological procedures expected by Cochrane methodology. MAIN RESULTS The searches identified 161 records; after de-duplication and title and abstract screening 90 full-text articles were retrieved. From these we included three RCTs with a combined total of 613 participants. One study compared prophylactic dactinomycin to no prophylaxis (60 participants); the other two studies compared prophylactic methotrexate to no prophylaxis (420 and 133 participants). All participants were diagnosed with CMs. We considered the latter two studies to be of poor methodological quality.P-Chem reduced the risk of GTN occurring in women following a CM (3 studies, 550 participants; risk ratio (RR) 0.37, 95% confidence interval (CI) 0.24 to 0.57; I² = 0%; P < 0.00001; low-quality evidence). However, owing to the poor quality (high risk of bias) of two of the included studies, we performed sensitivity analyses excluding these two studies. This left only one small study of high-risk women to contribute data for this primary outcome (59 participants; RR 0.28, 95% CI 0.10 to 0.73; P = 0.01); therefore we consider this evidence to be of low quality.The time to diagnosis was longer in the P-Chem group than the control group (2 studies, 33 participants; mean difference (MD) 28.72, 95% CI 13.19 to 44.24; P = 0.0003; low-quality evidence); and the P-Chem group required more courses to cure subsequent GTN (1 poor-quality study, 14 participants; MD 1.10, 95% CI 0.52 to 1.68; P = 0.0002; very low quality evidence).There were insufficient data to perform meta-analyses for toxicity, overall survival, drug resistance and reproductive outcomes. AUTHORS' CONCLUSIONS P-Chem may reduce the risk of progression to GTN in women with CMs who are at a high risk of malignant transformation; however, current evidence in favour of P-Chem is limited by the poor methodological quality and small size of the included studies. As P-Chem may increase drug resistance, delays treatment of GTN and may expose women toxic side effects, this practice cannot currently be recommended.
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Affiliation(s)
- Qiuyi Wang
- West China Second University Hospital, West China Women's and Children's HospitalDepartment of Obstetrics and Gynecology2 JiangtianluChengduSichuanChina610041
| | - Jing Fu
- West China Second University Hospital, Sichuan UniversityDepartment of Obstetrics and GynecologyChengduSichuanChina
- Ministry of EducationKey Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan UniversityChengduChina
| | - Lina Hu
- The Second Affiliated Hospital of Chongqing Medical UniversityThe Obstetrics and Gynecology Department76 Linjiang RdChongqingChina400010
| | - Fang Fang
- West China Second University Hospital, Sichuan UniversityDepartment of Obstetrics and GynecologyChengduSichuanChina
| | - Lingxia Xie
- West China Second University Hospital, West China Women's and Children's HospitalDepartment of Obstetrics and Gynecology2 JiangtianluChengduSichuanChina610041
| | - Hengxi Chen
- West China Second University Hospital, Sichuan UniversityDepartment of Obstetrics and GynecologyChengduSichuanChina
| | - Fan He
- The Second Affiliated Hospital of Chongqing Medical UniversityCenter for Reproductive Medicine, Department of Obstetrics and Gynecology74 Linjiang RoadChongqingChongqingChina400010
| | - Taixiang Wu
- West China Hospital, Sichuan UniversityChinese Clinical Trial Registry, Chinese Ethics Committee of Registering Clinical TrialsNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Theresa A Lawrie
- The Evidence‐Based Medicine Consultancy Ltd3rd Floor Northgate HouseUpper Borough WallsBathUKBA1 1RG
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Kelani AB, Kaka MM, Sanoussi S, Catala M. Spina bifida: a prospective study from a single neurosurgical center based on the National Hospital in Niamey (Niger). Childs Nerv Syst 2017; 33:1439-1440. [PMID: 28762042 DOI: 10.1007/s00381-017-3545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Aminath Bariath Kelani
- Service de Neurochirurgie Hôpital National de Niamey (HNN), Niamey, Niger. .,Faculté des Sciences de la Santé - Université Abdou Moumouni (UAM) de Niamey, Service de Neurochirurgie, Hôpital National de Niamey (HNN) - NIGER, BP 12932, Niamey, Niger.
| | - M M Kaka
- Service de Neurochirurgie Hôpital National de Niamey (HNN), Niamey, Niger
| | - S Sanoussi
- Service de Neurochirurgie Hôpital National de Niamey (HNN), Niamey, Niger.,Faculté des Sciences de la Santé - Université Abdou Moumouni (UAM) de Niamey, Service de Neurochirurgie, Hôpital National de Niamey (HNN) - NIGER, BP 12932, Niamey, Niger
| | - M Catala
- Sorbonne Université, UPMC Université Paris 06, UMR7622, F-75005, Paris, France.,CNRS, Institut de Biologie Paris Seine (IBPS) - Developmental Biology Laboratory, UMR7622, F-75005, Paris, France.,INSERM, ERL1156, F-75005, Paris, France.,Fédération de Neurologie, Groupe hospitalier Pitié-Salpêtrière-APHP, F-75013, Paris, France
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Abstract
"The battle of the sexes begins in the zygote" W. Reik and J. Walter. Complete hydatidiform mole (CHM) is a pathology of the placenta with androgenetic diploid origin (chromosomes only from paternal origin). Placental villi present an abnormal hyperproliferation and hydropic degeneration associated with the absence of embryo. Three mechanisms can be envisaged at its origin: (1) destruction/expulsion of the female pronucleus at the time of fertilization by one or two spermatozoa, the former being followed by an endoreplication of the male pronucleus (homozygous mole), (2) a triploid zygote (fertilization by two spermatozoa) leading to a haploid and a diploid clones. The diploid clone may produce a normal fetus while the haploid clone, after endoreplication, generates a complete hydatidiform mole, (3) a nutritional defect during the differentiation of the oocytes of the female embryo that will affect the integrity and maturity of her oocytes during her adult life and lead to hydatidiform mole. In countries with a poor medical health care system, moles can be invasive or, in rare cases, lead to gestational choriocarcinomas.
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Affiliation(s)
- Jean-Jacques Candelier
- Inserm, unité 1197, Interactions cellules souches-niches - physiologie, tumeurs et réparation tissulaire, hôpital Paul Brousse, bâtiment Lavoisier, 14, avenue Paul Vaillant Couturier, 94800 Villejuif, France ; et Université Paris-Saclay
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Abstract
The hydatidiform mole (HM) is a placental pathology of androgenetic origin. Placental villi have an abnormal hyperproliferation event and hydropic degeneration. Three situations can be envisaged at its origin: 1. The destruction/expulsion of the female pronucleus at the time of fertilization by 1 or 2 spermatozoa with the former being followed by an endoreplication of the male pronucleus leading to a complete hydatidiform mole (CHM) 2. A triploid zygote (fertilization by 2 spermatozoa) leading to a partial hydatidiform mole (PHM) but can also lead to haploid and diploid clones. The diploid clone may produce a normal fetus while the haploid clone after endoreplication generates a CHM 3. A nutritional defect during the differentiation of the oocytes or the deterioration of the limited oxygen pressure during the first trimester of gestation may lead to the formation of a HM. In countries with poor medical health care system, moles (mainly the CHM) can become invasive or, in rare cases, lead to gestational choriocarcinomas.
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Affiliation(s)
- Jean-Jacques Candelier
- a Unité 1197 INSERM, Stem cell-niches Interactions: Physiology , Tumors and Tissular Repair, Hôpital Paul Brousse, Bâtiment Lavoisier , Villejuif , France.,b University of Paris-Saclay , Saint-Aubin , France
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