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Journal of Medical Cases

Case Report

Volume 7, Number 6, June 2016, pages 239-241

Molar Pregnancy and Poor Obstetrics Outcome: Retrospective Evaluation of Six Cases

Gestational trophoblastic disease (GTD) is a group of pathologies that originate from the abnormal hyperproliferation of trophoblastic cells. GTD includes different conditions such as hydatidiform mole (HM) (complete or partial), invasive mole, gestational choriocarcinoma, placental-site trophoblastic tumor, and epithelioid trophoblastic tumor. The most common GTD is HM. HM is a gestational disease with abnormal development of the villous trophoblast and characterized by an excess of paternal to maternal genetic material. It occurs once in every 600 pregnancies in Western countries but at higher rates in the Middle East, Latin America, Africa, and the Far East [1-3]. The most important risk factors for the development of HM are maternal age, geographical factors including ethnicity, and a previous molar pregnancy [4].

Women with GTD history appear not to be at increased risk of adverse pregnancy outcomes, although there have been some reports of an increased risk of spontaneous abortion, recurrent HM, stillbirth [5, 6]. In this retrospective evaluation, we have aimed to report the obstetrical history features of our patients who have experienced HM in their previous pregnancies.

This retrospective study was conducted at the Division of Perinatal Medicine, Hacettepe University Faculty of Medicine from January 2010 to December 2012.

The demographic and clinical characteristics of the patients were achieved through patient files and electronic records of the hospital. Patient demographics (age, parity, gravida, etc.), obstetrics history, perinatal complications (miscarriage, chromosomal abnormalities, malformations, and stillbirth) were recorded.

A total of six patients with history for HM were admitted to our hospital from January 2010 to December 2012. The mean age of the pregnant patients was 31.33 ± 5.33 years (range: 24 - 39 years). The mean gravida of the patients was 3.83 ± 0.75 (range 3 - 5). Details are given in Table 1. There were two patients who had heterozygous mutation for methylene tetrahydrofolate reductase (MTHFR) enzyme. One patient had both factor V Leiden and methylene tetrahydrofolate reductase enzyme heterozygous mutation. Excluding HM pregnancies, these six patients had 17 pregnancies totally. Eleven pregnancies (64.7%) experienced obstetrical/perinatal complications during their pregnancies. The most common complication was miscarriage (five pregnancies in four patients). Other complications were anomalous fetus, motor and mental retarded child, ectopic pregnancy, preterm birth and stillbirth. Table 2 shows the evaluation of the patients in terms of obstetric outcome and hereditary thrombophilia.

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Table 1. Demographic Features of the Patients

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Table 2. Evaluation of the Patients in Terms of Obstetric Outcome and Hereditary Thrombophilia

Association of HM and poor pregnancy outcome still remains confusing. Many studies did not reveal adverse perinatal or maternal complications [7]. Results from earlier studies indicate that women with a history of HM can expect a normal subsequent reproductive outcome, except for a slightly increased risk of a recurrent HM [7, 8].

On the contrary, the results of a large national cohort study from Sweden could not demonstrate an association between a history of HM and adverse maternal outcomes in subsequent pregnancies [9]. They have demonstrated an evidence of an increased risk of large for gestational age birth, stillbirth, and preterm birth among women with a history of HM (OR (95% CI): 1.19, 1.13, and 1.13, respectively). They have also reported that women exposed to a previous HM had a 25% lower risk of gestational hypertensive disease and preeclampsia when compared to controls [9]. Our findings are consistent with recent literature because there were 11 pregnancies with obstetrical/perinatal complications (64.7%).

Previous studies revealed that overall recurrence risk for HM was 1.8% (1 in 55), or a 20-fold increase compared with baseline risk [6-10]. We did not observe recurrence of HM in our small series probably because of inadequate number of patients.

There have been a lot of published reports about the relationship between MTHFR polymorphism and genetic disorders such as Down’s syndrome, cleft lip and palate, congenital heart disease, and neural tube defect [11-13]. In our study, we have shown that 60% (3/5) of the patients had heterozygous mutation for MTHFR enzyme (impaired enzyme activity). When recent literature is reviewed, there were no paper about association between MTHFR enzyme mutation and HM. This DNA methylation disorder may be the triggering reason of empty oocyte which may be the reason of HM. We believe that further studies are needed to validate this finding.

In conclusion, we advise obstetricians to be careful when their patients experienced HM in their previous pregnancies.

Conflicts of Interest

The authors declare that there is no conflict of interest regarding the publication of this paper.

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