Ptyalism and partial hydatidiform mole associated with a normal term male fetus

Risk factors for gestational trophoblastic neoplasia development of singleton normal fetus with partial hydatidiform mole pregnancy: A retrospective cohort and literature review

INTRODUCTION

Singleton normal fetus with partial hydatidiform mole (PHM) pregnancy is a rare phenomenon. No previous reports have investigated the risk factors of gestational trophoblastic neoplasia (GTN) progression following this condition.

METHODS

We retrospectively enrolled cases of singleton normal fetuses with PHM pregnancies at West China Second University Hospital, Sichuan University, from 2005 to 2017. Other cases were identified from PubMed databases during 1975 to 2021 for the cohort study. Cox proportional hazards models were applied to evaluate risk factors for GTN progression based on the patient's clinical characteristics.

RESULTS

Overall, 36 cases of singleton normal fetuses with PHM pregnancies were enrolled. After a median follow-up of 4.0 (0.8-12.0) months, nine (25.0%) patients progressed to GTN. Gestational age at pregnancy termination (hazard ratio [HR] 0.88; 95% confidence interval [CI] 0.78-0.99, p = 0.032), hyperthyroidism (HR 5.75; 95% CI, 1.16-28.50, p = 0.032), and reasons for pregnancy termination (medical indications vs. patients' choice; HR 0.25; 95% CI, 0.06-0.99, p = 0.049) were significantly correlated with GTN progression. Area under the receiver operating characteristic curve (AUC) of gestational age at pregnancy termination to predict non-progression to GTN was 0.784 (95% CI, 0.615-0.903, p < 0.001). A clinically significant cutoff value, that is, gestational age of 24 weeks, was determined by comprehensively considering the cutoff values of AUC and clinical significance of gestational age.

CONCLUSIONS

Compared to gestational age of pregnancy termination <24 weeks, ≥24 weeks was a protective factor for GTN. Therefore, there is enough evidence to continue pregnancy, except for uncontrolled severe complications, without increasing the risk of GTN progression.

Partial molar pregnancy with live fetus complicated by intrauterine growth restriction and severe preeclampsia. Case report and review of the literature

OBJECTIVE

To report the case of a partial molar pregnancy with live fetus and conduct a review of the literature regarding maternal and fetal complications associated to this condition.

METHODS

Case report of a partial mole with a 33 weeks live fetus complicated by intrauterine growth restriction, oligohydramnios and severe preeclampsia. We report satisfactory maternal and neonatal outcomes and 1-year follow-up. A search was conducted in the Medline via Pubmed, Lilacs, Ovid, Uptodate and Google Scholar databases using the following MESH terms: hiditadiform mole, partial mole, live fetus, coexisting live fetus. Case series and case reports of pregnant women with coexisting partial mole and live fetus at the time of diagnosis were selected and information regarding maternal and fetal prognosis was extracted.

RESULTS

Initially, 129 related titles were identified. Of these, 29 met the inclusion criteria, and 4 articles were excluded due to failed access to the full text. Overall, 31 reported cases were included; 9 ended in miscarriage, 8 in fetal demise or perinatal death, and 14 (45 %) resulted in a live neonate. The most frequent maternal complication was preeclampsia in 6 (19.35 %) cases.

CONCLUSIONS

The coexistence of a partial mole with a live fetus poses a high risk of adverse perinatal outcomes and preeclampsia. The volume of information regarding this rare condition must be increased in order to better determine potential interventions in cases of euploid fetuses and to provide adequate counseling in clinical practice. Therefore, reporting these cases is important to build sufficient evidence about the natural course of this condition.

Ptyalism in pregnant women

Ptyalism affects few pregnant women. Those who suffer from it, however, find it to be a little-known, but major irritant. This article presents several possible etiologies and discusses some vexatious cases of ptyalism. Nursing interventions are also offered. More nursing research must be conducted so that nurses can better understand this problem.

Hydatidiform mole coexisting with a live fetus: a dilemma of management. A recent review (1965-1985) and report of 2 new cases

A review of 24 patients with a molar placenta and coexisting live fetus, including 2 new cases from the Queensland Trophoblastic Disease Registry, was made. The rate of fetal abnormalities was 33%; all 8 abnormal fetuses were female and in 5 of them in whom cultures were performed the chromosomal karyotype was triploidy 69XXX. There were 3 patients in whom malignant sequelae were detected (12%). After a confident ultrasound diagnosis of a molar placenta and a coexisting live fetus, the decision on whether the pregnancy should be terminated or allowed to continue should be based on the likelihood of the fetus being abnormal. It is recommended that the chromosomal karyotype and amniotic fluid alpha-fetoprotein level be determined by amniocentesis at about 16-18 weeks. This should allow those pregnancies in whom the fetus is potentially normal to be selected for conservative management.