Mola hidatiforme parcial del segundo trimestre / Second trimester partial hydatidiform mole

La mola hidatiforme coexistente con un feto vivo es una entidad infrecuente que se caracteriza por la degeneración hidrópica de las vellosidades coriales, hiperplasia del trofoblasto y evidencia macroscópica de un feto. El objetivo del trabajo fue describir el caso clínico de una paciente con diagnóstico de mola parcial y edad gestacional de 23 semanas. Presentamos una paciente de 31 años remitida de consulta de perinatología con 22,5 semanas de gestación, tensión arterial elevada, signo de más y ecografía con 20 semanas que describe placenta con lagos venosos; con antecedentes de alfafetoproteína elevada. En el hospital empeoró su estado con una preeclampsia agravada, y con ecografía evolutiva que describe placenta de 71 mm, con múltiples lagos venosos. Se plantea posible enfermedad trofoblástica y se discute para interrupción del embarazo. Se realizó microcesárea, se obtiene feto muerto femenino de 600 gramos, con placenta de 400 gramos con múltiples vesículas que recuerdan la mola parcial, diagnóstico que se confirma posteriormente con estudio histopatológico. En la mola parcial, el embrión rara vez sobrevive hasta el segundo trimestre. Si no se realizan pruebas citogenéticas, posiblemente no se diagnostiquen porque los cambios histológicos suelen ser sutiles. La clínica, la fracción beta de la gonadotropina coriónica y el estudio de la placenta, el feto o ambos, son los que permitirán realizar el diagnóstico definitivo para determinar el seguimiento y disminuir las complicaciones(AU)

The hydatidiform mole coexisting with a living fetus is a rare entity that is characterized by hydropic degeneration of the chorionic villi, hyperplasia of the trophoblast and macroscopic evidence of a fetus. The objective of the study was to describe the clinical case of a patient with a diagnosis of partial mole and gestational age of 23 weeks. We present a 31-year-old patient referred for perinatology consultation with 22.5 weeks of gestation, high blood pressure, plus sign and ultrasound with 20 weeks describing placenta with venous lakes; and history of high alpha-fetoprotein. In the hospital, her condition worsened with aggravated preeclampsia, and with an evolving ultrasound, that describes a 71 mm placenta with multiple venous lakes. Possible trophoblastic disease arises and is discussed for termination of pregnancy. Micro-cesarean surgery was performed, a female fetus weighing 600 grams was obtained, a placenta of 400 grams with multiple vesicles that resemble partial mole. This diagnosis is later confirmed with histopathological study. In partial mole, the embryo rarely survives until the second trimester. If cytogenetic tests are not performed, they may not be diagnosed because the histological changes are usually subtle. The clinic, the beta fraction of the chorionic gonadotropin and the study of the placenta, the fetus or both, are the ones that will make the definitive diagnosis to determine the follow-up and decrease the complications(AU)

Does a human chorionic gonadotropin level of over 20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole constitute an indication for chemotherapy for gestational trophoblastic neoplasia?

OBJECTIVE: To evaluate whether a human chorionic gonadotropin (hCG) level ≥20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole (CHM) is an appropriate indicator for initiating chemotherapy for the treatment of gestational trophoblastic neoplasia (GTN). STUDY DESIGN: Historical database review of 1228 women with CHM who received treatment and follow-up between January 2000 and June 2013 at four Brazilian trophoblastic disease centers. The primary outcome measure was the progression from CHM to GTN. The secondary outcomes were the occurrence of uterine perforation, staging of GTN, WHO/FIGO risk score, and treatment (use of single- or multiagent chemotherapy). RESULTS: An hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM, while occurring in only 6.1% of women, was the most important risk factor for the development of postmolar GTN (adjusted RR = 5.83; p < 0.01; CI: 3.47-9.79), with a sensitivity of 36.8%, a specificity of 98.6%, a positive predictive value of 80%, and a negative predictive value of 91.1%. On the other hand, there were no differences in postmolar GTN stage, prognostic score, or need for multiagent chemotherapy relative to hCG level ≥20,000 IU/L versus <20,000 IU/L. CONCLUSIONS: Although hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM was very predictive of development of post-molar GTN, delay in treatment until hCG plateau or increase did not affect outcomes, with no uterine perforations or treatment failures.

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

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.

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

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.

Mola hidatidiforme completa con preeclampsia e hipertiroidismo: presentación clásica / Complete hydatidiform mole with preeclampsia and hyperthyroidism: classic presentation

Introducción: La enfermedad trofoblástica gestacional es un espectro de enfermedades de la placenta, existiendo entre ellas algunas con potencial de invasión y metástasis, dentro de las cuales se incluye la mola invasiva, coriocarcinoma, tumores del sitio de inserción de la placenta y mola hidatidiforme. Esta última a su vez se divide en mola completa y parcial, diferenciándose en histopatología, morfología, cariotipo, malignización y comportamiento clínico, que es el punto al cual nos referiremos en este caso. Caso clínico: mujer de 46 años ingresa por hemoptisis, metrorragia, disnea a pequeños esfuerzos, ortopnea y disnea paroxística nocturna, asociado a hipertensión, taquicardia, masa hipogástrica firme e inmóvil y edema de extremidades. Se realiza ecografía abdominal compatible con MH y bhCG elevada. Evoluciona con crisis hipertensivas, insuficiencia cardiaca congestiva y tirotoxicosis. Inicia trabajo de parto expulsando 665 grs de mola, presentando posteriormente a legrado uterino anemia severa y shock hipovolémico, requiriendo transfusiones y drogas vasoactivas. Se recupera progresivamente con posterior control al alta de bhCG indetectable a los 6 meses. Discusión: Es infrecuenta en la actualidad la presentación clínica clásica de la mola hidatidiforme completa debido al diagnóstico y control precoz del embarazo asociado al uso masivo de la ecografía. Sin embargo es relevante tener un alto grado de sospecha de esta patología debido a sus graves consecuencias, y así realizar una derivación y manejo precoz.

Background: Gestational trophoblastic disease is a spectrum of diseases of the placenta, existing some with potential for invasion and metastasis, among which include invasive mole, choriocarcinoma, tumors of the insertion site of the placenta and hydatidiform mole. The last one is divided into complete and partial mole, differing in histopathology, morphology, karyotype, and clinical malignant behavior, witch is the point we refer to in this case. Case report: 46 year old woman admitted for hemoptysis, metrorrhagia, dyspnea on slight exertion, orthopnea and paroxysmal nocturnal dyspnea associated with hypertension, tachycardia, firm and immovable hypogastric mass and limb edema. Abdominal ultrasound compatible with MH and high BhCG is performed. Evolve with hypertensive crisis, congestive heart failure and thyrotoxicosis. Labor starts driving out 665 grams of mole, after the curettage present hypovolemic shock and severe anemia requiring transfusions and vasoactive drugs. It gradually recovers further control the discharge of BhCG undetectable at 6 months. Discussion: It is currently infrequent classical clinical presentation of complete hydatidiform mole due to early diagnosis and management of pregnancy associated with the widespread use of ultrasound. However it is important to have a high degree of suspicion of this disease because of its serious consequences, and thus make a referral and early management.

Complicações clínicas da gravidez molar / Clinical complications of hydatidiform mole

A gravidez molar, espectro benigno da doença trofoblástica gestacional, representa uma complicação obstétrica da primeira metade da gestação. De maneira geral, cursa com sintomatologia exuberante: hemorragia, útero aumento para a idade gestacional, cistose ovariana e pré-eclâmpsia precoce; chegando mesmo a graves situações clínicas de hipertireoidismo e insuficiência respiratória.Todavia, devido ao diagnóstico precoce da mola hidatiforme, ainda no primeiro trimestre, mercê da ultrassonografia, houve uma importante redução na ocorrência desses sintomas; contribuindo para que a condução desses casos excepcionais ficasse confinada aos Centros de Referência. É objetivo desse artigo apresentar ao obstetra brasileiro uma revisão das complicações clínicas da gravidez molar, atualizando-o no diagnóstico precoce e tratamento dessas condições clínicas que podem ser potencialmente ameaçadoras à vida da gestante e de seu concepto.(AU)

The molar pregnancy, in the benign gestational trophoblastic disease spectrum, represents an obstetric complication of first half of gestation. In general, runs with exuberant symptoms: bleeding, uterus increase for gestational age, ovarian cistose and early preeclampsia; even serious clinical situations of hyperthyroidism and respiratory failure. However, due to the early diagnosis of hydatidiform mole, still in the first trimester, through ultrasound, there was a significant reduction in the occurrence of these symptoms; contributing so that the conduct of these exceptional cases could be confined to the centers of reference. The purpose of this article is to present to the Brazilian obstetrician a review of clinical complications of molar pregnancy, updating it in the early diagnosis and treatment of clinical conditions that can be potentially threatening to the life of the pregnant woman and her fetus.(AU)

Gestação gemelar com mola hidatiforme completa e feto vivo / Twin pregnancy with a complete hydatidiform mole and live fetus

A gestação gemelar com mola hidatiforme completa que coexiste com feto vivo (GGMC) é uma entidade rara. Embora as recomendações sejam de conduta expectante, são descritas diversas complicações maternas e fetais, como o aumento da incidência de abortamento espontâneo, de parto prematuro, de sangramento vaginal, de pré-eclampsia grave e de doença trofoblástica persistente, entre outras complicações. Neste trabalho, descrevemos a evolução clínica de um caso de GGMC que evoluiu para crise tireotóxica, pré-eclâmpsia grave, interrupção da gestação e necessidade de cuidados intensivos maternos. A necropsia fetal evidenciou feto do sexo feminino, sem malformações aparentes, com alterações placentárias que favorecem cromossomopatia. A avaliação dos restos ovulares evidenciou vilosidades com hiperplasia do trofoblasto e vesículas, achados compatíveis com mola hidatiforme completa. Atualmente, após 15 meses de seguimento, a paciente permanece assintomática e com níveis indetectáveis de gonadotrofina coriônica.

Twin pregnancy with complete hydatidiform mole coexisting with a live fetus is a rare entity, and although the recommendations are expectant management of various maternal and fetal complications are described, such as increasing the number of spontaneous abortion, premature delivery, vaginal bleeding, pre-eclampsia and severe persistent trophoblastic disease, among other complications. In this paper, we describe the clinical course of a case of GGMC who developed thyrotoxic crisis, preeclampsia severe, termination of pregnancy and maternal need for intensive care. Fetal autopsy showed a female fetus with no apparent defects; with placental changes favoring chromosomal disorders. The evaluationof ovular remains showed villi with trophoblastic hyperplasia and vesicles, suggestive of complete mole. Currently, after 15 months of follow up, the patient remains asymptomatic with undetectable levels of chorionic gonadotropin.

Impacto da ingestão dietética e do estresse oxidativo em pacientes com doença trofoblástica gestacional / Impact of dietary intake and oxidative stress in patients with gestational trophoblastic disease

A doença trofoblástica gestacional (DTG) é um termo aplicado a um grupo de tumores relacionados à gestação, caracterizando formas benignas (mola hidatiforme - MH) e malignas (neoplasia trofoblástica gestacional - NTG). O estresse oxidativo, a ingestão dietética e o estado nutricional da gestante constituem possíveis fatores de risco para a ocorrência da MH e sua progressão para NTG. A presente revisão tem como objetivo abordar a relação entre essas entidades. Apesar de haver evidências mostrando que a ingestão dietética e o estresse oxidativo possam ter papéis relevantes na etiopatogênese da DTG, ainda são necessários muitos estudos para uma melhor investigação da atuação desses agentes na gravidez molar e suas sequelas malignas e proliferativas.(AU)

The gestational trophoblastic disease (GTD) is a term applied to a rare group of pregnancy related tumors of benign forms (hydatidiform mole - HM) as well as malignant ones (gestational trophoblastic neoplasia - GTN). Oxidative stress, dietetic intake and nutritional status of pregnant women are possible risk factors for the occurrence of HM and its progression to GTN. This review aims to address the relationship between these entities. Besides the evidences supporting that dietetic intake and oxidative stress may have important roles in the GTD etiopathogenesis, many studies are needed to better investigate the role of these agents in molar pregnancy and their proliferative and malignant sequelae.(AU)

Mola hidatiforme completa y feto vivo a término coexistente: reporte de caso / Complete hydatidiform mole and alive fetus to term coexistent. case report

Se presenta el caso de una mola hidatiforme completa y feto vivo a término coexistente en una paciente de 30 años, II gestas I para, con embarazo de 29 semanas y elevación de la presión arterial. La imagen ecográfica al ingreso de la placenta sugirió la presencia de mola hidatiforme junto a un feto normal. Se realizó seguimiento expectante hasta las 37 semanas, cuando presentó un episodio de sangrado genital por lo que se realizó una cesárea y se obtuvo un recién nacido vivo masculino normal, placenta y una tumoración de un tejido vesicular. El examen de anatomía patológica del tejido vesicular reportó mola hidatiforme completa.

A case of complete hydatiform mole with live term coexisting fetus in a 30-year-old patient, II gravida, 1 para, with a pregnancy of 29 weeks and rise of blood pressure is presented. Ultrasound image at admission suggested the presence of hydatiform mole together a live fetus. Patient was followed until 37 weeks, when presented an episode of vaginal bleeding cause a cesarean section was done and a live normal male newborn, placenta and a vesicular tissue tumor were obtained. Pathology exam of vesicular tissue reported complete hydatiform mole.

[Acute abdomen as a complication of a molar pregnancy]. / Abdomen agudo como complicación de un embarazo molar.

UNLABELLED: To report a case of bilateral ovarian torsion after a molar pregnancy. CLINICAL CASE: An 18 year old female was admitted for a 7 week molar pregnancy. A week after uterine evacuation the patient was readmitted to the emergency room with acute abdomen. Exploratory laparotomy revealed torsion and necrosis of both ovaries. A bilateral salpingo-oophorectomy was performed. The anatomopathology study confirms both ovaries with hyperrectio luteinalis and hemorrhagic infarct. Acute abdomen secondary to torsion and necrosis of thecalutein cysts can be a molar pregnancy-related complication.

A review of molar pregnancy at the university hospital of the West Indies over a 16-year period.

There is a wide variation in reported incidence, risk factors and presentation of molar pregnancy. This necessitates population-based studies to determine these parameters at the University Hospital of the West Indies, which is a referral centre for these conditions. The incidence of molar pregnancy at the University Hospital of the West Indies was found to be 2.81 per 1,000, which fell in the range of worldwide values. Partial moles made up 61.1% and complete moles 31.0%. The mean age of the patients was 28.49 years old with 85% of patients aged between 20 and 40 years old. The median gestational age by dates was 12 weeks and vaginal bleeding was the most common presenting symptom (77%). A significant number of cases (52.2%) of molar pregnancy were diagnosed by routine histopathology for failed pregnancy and not by pre-evacuation ultrasound. The practice of routine assessment of tissue from failed pregnancy should therefore be encouraged in our population.

[Partial mole and atypical preeclampsia: a case report and review of the literature]. / Mola parcial y preeclampsia atípica: reporte de un caso y revisión de la bibliografía.

We report the case of 23 years old primingesta patient with a partial molar pregnancy 16 weeks, studying with atypical presentation of preeclampsia (high blood pressure 160/100 mmHg, proteinuria of 3.4 g in 24 hours, headache, photophobia and anasarca), so differential diagnoses ruled out (lupus nephritis, hemolytic uremic syndrome, antiphospholipid antibody syndrome, thrombotic thrombocytopenic purpura, nephrotic syndrome). Disengage vaginally were required by the presence of deterioration of maternal health with systemic repercussions. We observed marked improvement in health status after disengage.

Crise tireotóxica associada à doença trofoblástica gestacional / Thyrotoxic crisis associated with gestational trophoblastic disease

JUSTIFICATIVA E OBJETIVOS: A gonadotrofina coriônica humana (HCG) e o hormônio tireotrófico (TSH) apresentam analogia entre suas estruturas, assim como seus receptores. Os altos níveis de HCG encontrados nas doenças trofoblásticas gestacionais podem induzir um quadro de hipertireoidismo secundário. O objetivo deste relato é apresentar um caso em que a administração de contraste iodado precipitou um quadro de crise tireotóxica. RELATO DO CASO: Paciente com mola hidatiforme completa foi admitida no centro cirúrgico com sangramento vaginal intenso após realização de tomografia com contraste iodado. Durante indução anestésica, paciente apresentou quadro compatível com crise tireotóxica. CONCLUSÕES: A incidência de quadros graves associados à doença trofoblástica gestacional tende a diminuir com seu diagnóstico precoce. Ainda que isso aconteça, o anestesiologista deve estar atento à possibilidade de crise tireotóxica nesses pacientes.

BACKGROUND AND OBJECTIVES: Human chorionic gonadotropin (HCG) and thyrotrophic hormone (TSH) have analogies in their structures, as well as in their receptors. The high levels of HCG seen in gestational trophoblastic diseases may induce secondary hyperthyroidism. The objective of this report was to present a case in which the administration of iodinated contrast triggered a thyrotoxic crisis. CASE REPORT: Patient with complete hydatidiform mole who was admitted to the operating room with severe vaginal bleeding after a tomographic exam with iodinated contrast. During anesthetic induction, the patient presented symptoms compatible with thyrotoxic crisis. CONCLUSIONS: The incidence of severe presentations associated with gestational trophoblastic disease tends to decrease with early diagnosis. Still, the anesthesiologist should be aware of the possibility of those patients developing thyrotoxic crisis.

JUSTIFICATIVA Y OBJETIVOS: La HCG y el TSH presentan una analogía entre sus estructuras, como también sus receptores. Los altos niveles de HCG encontrados en las enfermedades trofoblásticas de la gestación pueden inducir a un cuadro de hipertiroidismo secundario. El objetivo de este relato es presentar un caso en que la administración de contraste yodado precipitó un cuadro de crisis tirotóxica. RELATO DEL CASO: Paciente con mola hidatiforme completa que entró en quirófano con sangramiento vaginal intenso después de la realización de una tomografía con contraste yodado. Durante la inducción anestésica, la paciente presentó un cuadro compatible con la crisis tirotóxica. CONCLUSIONES: La incidencia de cuadros graves asociados a la enfermedad trofoblástica gestacional tiende a reducirse con su diagnóstico precoz. Pero incluso si eso ocurre, el anestesiólogo debe estar atento a la posibilidad de una crisis tirotóxica en esos pacientes.

[Twin pregnancy with complete mole and coexisting fetus after in vitro fertilization and embryo transfer complicated with placenta previa accreta. A case report]. / Embarazo gemelar con mola completa y feto coexistente posterior a fertilización in vitro y transferencia de embriones complicado con placenta previa acreta. Reporte de un caso.

The double twin pregnancy with complete hydatidiform mole and coexistent fetus is a rare event and perinatal treatment complex. Presents a significant case of this unusual partnership and describes their evolution. Patient of 33 years, secondary infertility factor-peritoneal tube and pregnancy achieved by in vitro fertilization and embryo transfer. An ultrasound early pregnancy reported twice, a sack was a complete mole, another bag was a fetus and placenta previa unchanged total. The case is carefully monitored and uterine inhibitors were administered at different stages of gestation. It settled the case by caesarean section at 37 weeks and obstetric hysterectomy for placenta previa percreta molar involution of the placenta and newborn health. The evolution of the mother and the child was appropriate.

Gestational trophoblastic neoplasia: clinical trends in 8 years at Hospital Universitario de Caracas.

OBJECTIVE: To analyze the clinical trends of gestational trophoblastic neoplasia (GTN) at the Department of Obstetrics and Gynecology, Hospital Universitario de Caracas (HUC). STUDY DESIGN: A medical record review was performed of epidemiologic, clinical and diagnostic features of 25 cases of GTN at HUC from 1997 to 2004. RESULTS: During the study period, 35,300 deliveries occurred, and 25 patients were diagnosed with GTN; the prevalence was 0.70:1,000 deliveries. The mean age was 29.2 years. Fifty-six percent were posthydatidiform mole (HM), 36% postchoriocarcinoma (CC), 4% postinvasive mole and 4% postabortion with abundant intermediate trophoblast. Vaginal bleeding was the main symptom in patients with CC. Two cases resembled ectopic pregnancy, and another resembled a vaginal endometrioma. Fifty-two percent of cases were at stage Ib; 76% received single-agent chemotherapy. Hysterectomy was performed in 6 cases. Twenty-one patients achieved remission, 2 showed regression and 2 died. CONCLUSION: GTN had a high prevalence because HUC is a reference center. The most common presentation was post-HM GTN. Vaginal bleeding is frequent in CC and can mimic other gynecologic diseases. Chemotherapy is helpful, and hysterectomy can be performed in selected cases at early stages or with severe vaginal bleed-with a good ing. GTN has a good prognosis, and early diagnosis is possible.

Feto con trisomía 18 asociado a mola parcial / Fetus with trisomy 18 associated to partial molar

We present a 38 years old women G2P1A1 who was detected hydramnios; fetal growth restriction, altered Doppler and multiple vesicular forms in the placental structure; at 24 weeks of gestation. A genetic study in amniotic fluid was performed and we determinate a 18 trisomy. The labour begun spontaneously at her´s 32 weeks of gestation, showing us a masculine fetus who had, fenotipically, a small heel malformation. In the macroscopic exam of the placenta, we saw a multicystic form in approximately 15 percent of its structure. The histology demostrated partial molar degeneration and trophoblastic hyperplasia.

Se presenta el caso de una paciente de 38 años, G2P1A1, quien a las 24 semanas de gestación le fue pesquisado un polihidroamnios, asociado a restricción de crecimiento intrauterino, Doppler materno alterado y múltiples imágenes vesiculares en relación a la placenta. Se realizó estudio genético en líquido amniótico que determinó la presencia de una trisomía 18. El trabajo de parto se inicio espontáneamente a las 32 semanas y se obtuvo un producto masculino de 950 gramos, fenotípicamente sólo presentaba leve malformación del talón (talón enpiolet). Al examen macroscópico la placenta presentaba múltiples zonas con vesículas grandes y pequeñas en +/- 15 por ciento de su estructura. El estudio histológico demostró degeneración molar parcial con hiperplasia trofoblástica.

Síndrome da hiperestimulação ovariana como complicação da mola hidatiforme / Ovarian hyperstimulation syndrome as hydatidiform mole complication

A síndrome da hiperestimulação ovariana (SHO) é caracterizada por uma importante transudação de líquido doespaço intravascular para o terceiro espaço. Em geral, ela é uma complicação de técnicas de reprodução assistida. A SHO é um evento extremamente raro em gestações espontâneas e, contrariamente ao que se esperaria, mais raro ainda em gestações molares. Relatamos o caso de uma mulher de 27 anos, com gestação molar de 9 semanas e com ecografia que evidenciava inúmeros cistos tecaluteínicos em ambos os ovários que foi submetida a esvaziamento a vácuo da cavidade uterina e 5 dias após o esvaziamento desenvolveu um quadro de SHO severa. A paciente evoluiu com taquicardia, distensão abdominal, dispnéia, oligúria, derrame pleural e ascite. Ela foi submetida a três paracenteses de alívio e à punção dos cistos tecaluteínicos, guiados por ultra-som. Posteriormente, foi submetida a laparotomia exploradora por suspeita de torção anexial. A paciente ficou internada por 30 dias sendo que uma semana na Unidadede Cuidados Intensivos. Foram necessários dois meses para o desaparecimento dos cistos tecaluteínicos, emboraecograficamente o ovário apresenta-se multifolicular e 5 meses para a regressão completa do BHCG

[Unsuspected molar pregnancy in first trimester miscarriages]. / Embarazo molar no sospechado en abortos del primer trimestre.

OBJECTIVE: To assess the prevalence of unsuspected molar pregnancy in patients with first trimester spontaneous abortions. METHODS: An observational, cross-section study was carried out in 396 consecutive patients with diagnosis of first trimester spontaneous abortions, without clinical or ultrasonographic findings suggesting hydatidiform mole, a histological diagnosis was made from the curettage specimens, the cases with diagnosis of any trophoblastic disease prior of curettage were not included in the study. RESULTS: Diagnosis of molar pregnancy was made in 48 out of 396 patients (12.1%). There was not statistical difference in the sociodemographic variables and risk factors analyzed: patient age, familial incomes, years in scholar courses, prior pregnancies, deliveries, spontaneous abortions, number of sons, and prior hormone contraceptive use between the patients with diagnosed molar pregnancy and those patients without the diagnosis of molar pregnancy. CONCLUSION: The prevalence of unsuspected molar pregnancy found in our study (12.1%) was high and the suspicion in these cases according the risk factors of the disease could be difficult, therefore to rule out systematically molar pregnancy in each case of spontaneous abortions is recommended in order to avoid the complications associated with hydatidiform mole.