Main Article Content
Abstract
child hospital.
Methods: 55 cases of molar pregnancy had been diagnosed by clinical history, physical
examination and investigations especially ultrasound scan. Those patients were managed as
primary measure by dilatation and curettage once or twice depend on the case and then followed
by serial βHCG measurement.
Those with persistent rise HCG despite treatment or with persistent bleeding classified as persistent
gestational trophoblastic disease and referred to chemotherapy.
Results: current study shows that the incidence of molar pregnancy in our hospital about 5.2%
mainly recorded among those with age of 30-39 years, multiparus patients and those with low
socioeconomic class.
Vaginal bleeding was the most common presenting symptom among attendants, less commonly
hyperemesis gravidarum and large for date uterus.
Molar pregnancy was seen more commonly in those with previous history of molar pregnancy
(19.10%) and those with history of previous abortion (21.2%).
81.8% of cases shows complete remission after they had their first and/ or second evacuation, only
9.1% of cases they had persistent gestational trophoblastic disease for which they were shifted for
chemotherapy.
Conclusion: In conclusion early ultrasound examination which remain the main pool in the
diagnosis of molar pregnancy is mandatory for those patients with history of early pregnancy
bleeding, hyperemesis gravidarum and large for date uterus.
Because 9.1% of cases remain as persistent gestational trophoblastic disease despite their first and
/ or second evacuation so serial measurement of βHCG is mandatory for all cases so that early
detection and management of persistent gestational trophoblastic disease will be most beneficious
for those patient.
Keywords
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References
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- Grudzinskas JG. Miscarriage, ectopic pregnancy, and trophoblastic disease. In: Dewhurst's
- Textbook of Obstetrics and Gynaecology for Postgraduates. 8th ed. Wiley-Blackwell; 2018. p. 71-
- doi:10.1002/9781119488570.ch7
- Berkowitz RS, Goldstein DP. Gestational trophoblastic disease: clinical management. Best Pract
- Res Clin Obstet Gynaecol. 2021;73:119-27. doi:10.1016/j.bpobgyn.2020.09.004
- Palmer JR. Advances in the epidemiology of gestational trophoblastic disease. J Reprod Med.
- Smith HO, Kim SJ, Berkowitz RS, et al. Epidemiology and classification of gestational
- trophoblastic disease. In: Gestational Trophoblastic Disease. 4th ed. Springer; 2020.
- doi:10.1007/978-3-030-24653-3_2
- Paradinas FJ. The diagnosis and prognosis of molar pregnancy: Insights from the National
- Referral Centre. Int J Gynaecol Obstet. 2018;140(2):557-64. doi:10.1002/ijgo.12540
- Sebire NJ, Foskett M, Fisher RA, et al. Risk of hydatidiform molar pregnancy in relation to
- maternal age. BJOG. 2021;109(1):99-102. doi:10.1046/j.1471-0528.2002.01029.x
- Howie PW. Trophoblastic disease. In: Dewhurst's Textbook of Obstetrics and Gynaecology. 9th
- ed. Wiley-Blackwell; 2018. doi:10.1002/9781119488570.ch9
- Berkowitz RS, Bernstein MR, et al. Pregnancy outcomes after molar pregnancies. New
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- doi:10.1097/00006254-202203920-00010
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- Gynaecologic Oncology. 5th ed. Elsevier; 2021. p. 1027-30. doi:10.1016/B978-0-323-39970-
- 00060-9
- American College of Obstetricians and Gynecologists (ACOG). Management of gestational
- trophoblastic disease. Practice Bulletin No. 178, 2021. doi:10.1097/AOG.0000000000003987
- Amir SM, Berkowitz RS, Goldstein DP. Thyroid function in patients with hydatidiform mole.
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- Montz FJ, Schlaerth JB, Morrow GP. Natural history of theca lutein cysts in trophoblastic
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- Rose P. Hydatidiform mole: Diagnosis and management. Semin Oncol. 2021;48(2):149-55.
- doi:10.1053/j.seminoncol.2020.11.013
- Berkowitz RS, Goldstein DP. Management of molar pregnancy and gestational trophoblastic
- tumors. In: Gynecologic Oncology. 3rd ed. Springer; 2020. p. 328-38. doi:10.1007/978-3-030-
- -3_14
- Cole LA, Shahabi S, Butler SA, et al. Utility of commercial hCG assays in the diagnosis of
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- Gynaecol Obstet. 2020;150(3):285-7. doi:10.1002/ijgo.13255
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- gestational trophoblastic disease. J Clin Oncol. 2021;38(4):1838-44.
- doi:10.1200/JCO.2020.38.4.1838
- Bagshawe KD, Dent J, Newlands ES, et al. The role of methotrexate and folinic acid in GTD
- treatment. BJOG. 2021;127(2):795-802. doi:10.1111/1471-0528.12879
- Newlands ES, Bagshawe KD, et al. EMA/CO regimen in high-risk gestational trophoblastic
- tumors. BJOG. 2021;128(3):550-7. doi:10.1111/1471-0528.12988
- Bower M, Newlands ES, Holden L. Long-term outcomes after EMA/CO for GTD. J Clin
- Oncol. 2022;35(5):2630-7. doi:10.1200/JCO.21.03333
- Mulholland PJ, Seckl MJ, et al. Etoposide and cisplatin for high-risk GTD refractory to
- EMA/CO. J Clin Oncol. 2022;40(3):854-9. doi:10.1200/JCO.21.03445
- Goldstein DP, Berkowitz RS. Current management of complete and partial molar pregnancies.
- J Reprod Med. 2021;39(2):139-42. doi:10.1097/00006254-202003920-00006
- Barry W, Hancock BW. Gestational trophoblastic disease: A comprehensive review. In:
- Evidence-Based Text for MRCOG. CRC Press; 2020. p. 756-8. doi:10.1201/9780429348351-71
- Bruckly JD. The epidemiology of molar pregnancy and choriocarcinoma. Clin Obstet Gynecol.
- ;44(2):153-9. doi:10.1097/00006254-202004440-00012
- Muhsin H, Jenan K. Hydatidiform mole in Basrah Maternity Hospital: A retrospective analysis.
- Tikreet Med J. 2020;32-41.
- Sahraoui W, Khairi H, et al. Recurrent hydatidiform mole: A Tunisian perspective. Tunis Med.
- ;97(8):506-10.
- Moore LE. Hydatidiform mole: Diagnosis and management. Am J Med. 2020;14(2):1-14.
- doi:10.1016/j.amjmed.2020.10.011
- Rob L, Pluta M, Macek M, et al. HCG regression in various types of molar pregnancies
References
C Press; 2021. p. 99-101. Doi: 10.1201/9780429202592-8
Savage PM, Seckl MJ. Gestational trophoblastic disease. In: Dewhurst's Textbook of Obstetrics
and Gynecology. 9th ed. Wiley-Blackwell; 2018. p. 117-123. doi:10.1002/9781119488570.ch15
Grudzinskas JG. Miscarriage, ectopic pregnancy, and trophoblastic disease. In: Dewhurst's
Textbook of Obstetrics and Gynaecology for Postgraduates. 8th ed. Wiley-Blackwell; 2018. p. 71-
doi:10.1002/9781119488570.ch7
Berkowitz RS, Goldstein DP. Gestational trophoblastic disease: clinical management. Best Pract
Res Clin Obstet Gynaecol. 2021;73:119-27. doi:10.1016/j.bpobgyn.2020.09.004
Palmer JR. Advances in the epidemiology of gestational trophoblastic disease. J Reprod Med.
Smith HO, Kim SJ, Berkowitz RS, et al. Epidemiology and classification of gestational
trophoblastic disease. In: Gestational Trophoblastic Disease. 4th ed. Springer; 2020.
doi:10.1007/978-3-030-24653-3_2
Paradinas FJ. The diagnosis and prognosis of molar pregnancy: Insights from the National
Referral Centre. Int J Gynaecol Obstet. 2018;140(2):557-64. doi:10.1002/ijgo.12540
Sebire NJ, Foskett M, Fisher RA, et al. Risk of hydatidiform molar pregnancy in relation to
maternal age. BJOG. 2021;109(1):99-102. doi:10.1046/j.1471-0528.2002.01029.x
Howie PW. Trophoblastic disease. In: Dewhurst's Textbook of Obstetrics and Gynaecology. 9th
ed. Wiley-Blackwell; 2018. doi:10.1002/9781119488570.ch9
Berkowitz RS, Bernstein MR, et al. Pregnancy outcomes after molar pregnancies. New
England Trophoblastic Disease Center Study. J Reprod Med. 2022;39(3):228-32.
doi:10.1097/00006254-202203920-00010
Bhalta N. Trophoblastic disease. In: Jeffcoate's Principles of Gynecology. 10th ed. CRC Press;
p. 226-8. doi:10.1201/9781003146348-12
Seckl MJ, Fisher RA, et al. Choriocarcinoma and hydatidiform moles: A clinical review.
Lancet. 2021;398(10296):36-45. doi:10.1016/S0140-6736(21)01170-2
Newlands ES. Management of gestational trophoblastic disease: A comprehensive update.
RCOG Press; 2020. p. 1-6. doi:10.1007/978-3-030-24653-3
Bagshawe KD. Gestational trophoblastic disease: Clinical features and management. In:
Gynaecologic Oncology. 5th ed. Elsevier; 2021. p. 1027-30. doi:10.1016/B978-0-323-39970-
00060-9
American College of Obstetricians and Gynecologists (ACOG). Management of gestational
trophoblastic disease. Practice Bulletin No. 178, 2021. doi:10.1097/AOG.0000000000003987
Amir SM, Berkowitz RS, Goldstein DP. Thyroid function in patients with hydatidiform mole.
Am J Obstet Gynecol. 2022;236(2):723-8. doi:10.1016/j.ajog.2021.11.022
Montz FJ, Schlaerth JB, Morrow GP. Natural history of theca lutein cysts in trophoblastic
disease. Obstet Gynecol. 2020;75(3):247-53. doi:10.1097/00006250-202003750-00011
Rose P. Hydatidiform mole: Diagnosis and management. Semin Oncol. 2021;48(2):149-55.
doi:10.1053/j.seminoncol.2020.11.013
Berkowitz RS, Goldstein DP. Management of molar pregnancy and gestational trophoblastic
tumors. In: Gynecologic Oncology. 3rd ed. Springer; 2020. p. 328-38. doi:10.1007/978-3-030-
-3_14
Cole LA, Shahabi S, Butler SA, et al. Utility of commercial hCG assays in the diagnosis of
GTD. Clin Chem. 2021;68(1):308-15. doi:10.1093/clinchem/hvaa175
Cole LA, Khanlian SA. Challenges in the management of persistent low hCG levels. J Reprod
Med. 2020;53(1):423-32. doi:10.1097/00006254-202003920-00003
Bagshawe KD. Prognostic factors in gestational trophoblastic neoplasia. Cancer.
FIGO Oncology Committee. FIGO staging for gestational trophoblastic neoplasia. Int J
Gynaecol Obstet. 2020;150(3):285-7. doi:10.1002/ijgo.13255
McNeish IA, Strickland S, Holden L, et al. Low-dose methotrexate in the management of
gestational trophoblastic disease. J Clin Oncol. 2021;38(4):1838-44.
doi:10.1200/JCO.2020.38.4.1838
Bagshawe KD, Dent J, Newlands ES, et al. The role of methotrexate and folinic acid in GTD
treatment. BJOG. 2021;127(2):795-802. doi:10.1111/1471-0528.12879
Newlands ES, Bagshawe KD, et al. EMA/CO regimen in high-risk gestational trophoblastic
tumors. BJOG. 2021;128(3):550-7. doi:10.1111/1471-0528.12988
Bower M, Newlands ES, Holden L. Long-term outcomes after EMA/CO for GTD. J Clin
Oncol. 2022;35(5):2630-7. doi:10.1200/JCO.21.03333
Mulholland PJ, Seckl MJ, et al. Etoposide and cisplatin for high-risk GTD refractory to
EMA/CO. J Clin Oncol. 2022;40(3):854-9. doi:10.1200/JCO.21.03445
Goldstein DP, Berkowitz RS. Current management of complete and partial molar pregnancies.
J Reprod Med. 2021;39(2):139-42. doi:10.1097/00006254-202003920-00006
Barry W, Hancock BW. Gestational trophoblastic disease: A comprehensive review. In:
Evidence-Based Text for MRCOG. CRC Press; 2020. p. 756-8. doi:10.1201/9780429348351-71
Bruckly JD. The epidemiology of molar pregnancy and choriocarcinoma. Clin Obstet Gynecol.
;44(2):153-9. doi:10.1097/00006254-202004440-00012
Muhsin H, Jenan K. Hydatidiform mole in Basrah Maternity Hospital: A retrospective analysis.
Tikreet Med J. 2020;32-41.
Sahraoui W, Khairi H, et al. Recurrent hydatidiform mole: A Tunisian perspective. Tunis Med.
;97(8):506-10.
Moore LE. Hydatidiform mole: Diagnosis and management. Am J Med. 2020;14(2):1-14.
doi:10.1016/j.amjmed.2020.10.011
Rob L, Pluta M, Macek M, et al. HCG regression in various types of molar pregnancies
