Boufettal H, Coullin P, Mahdaoui S, Noun M, Hermas S, Samouh N
Faculté de médecine et de pharmacie, service de gynécologie-obstétrique C, centre hospitalier universitaire Ibn Rochd, université Hassan 2, Aïn Chok, Casablanca, Morocco.
J Gynecol Obstet Biol Reprod (Paris). 2011 Sep;40(5):419-29. doi: 10.1016/j.jgyn.2011.02.008. Epub 2011 Mar 31.
Complete hydatidiform moles (CHM) are a real public health problem, especially in the "southern countries" and Asia, because of their impact on the female reproduction and the risk to progression to either invasive mole or choriocarcinoma.
We collected the cases of CHM referred to our department over a period of ten years (2000 to 2009). We will present our results, emphasize the modalities of diagnosis, treatment and evolution, with a review of literature.
During this study, we identified 254 cases of CHM, and recorded 57,987 births and 1627 abortions. Their incidence was 0.43% of pregnancies. The mean age of our patients is 25 years old (16 to 55). Relative risk observed was much increased among women under 20 years old (×6.8) and those over 40 years old (×15). Both of nulliparous and primiparous patients represented 52.3% of the cohort. Eighty-five percent of patients belonged to an agricultural environment associated with a low socio-economic status. Uterine bleeding was the most common symptom accounting for 93.7%. Toxic syndrome was present in 18.5% of patients. Physical examination showed a highly increased uterine size in 85% of cases associated with lateral uterine mass in 25% of cases. The diagnosis was suspected using ultrasonography in all cases associated with an elevated level of plasmatic β-human chorionic gonadotrophin (βhCG). All cases were confirmed histologically. Treatment used was endo-uterine aspiration in all cases. Recurrence of CHM was documented in 25 patients or 9.4%. Neoplasic progression was observed for 6.3% of cases. All of them have evolved into remission with chemotherapy.
CHM continue to be a public health problem in Morocco, their incidence is among the highest ones. In fact, this studied population corresponds to the lowest socio-economic status and generally described as population at risk. It is subject to drastic weather's conditions causing loss of fresh products. Extreme ages and degree of parity are also risk factors described in the literature. Early diagnosis, appropriate treatment, and supervision of molar pregnancies are obligatory. Despite of the unfavourable initial conditions, our study shows that relevance and continuing care can significantly reduce the morbidity of moles.
完全性葡萄胎是一个切实的公共卫生问题，尤其在“南方国家”和亚洲，因为其对女性生殖系统有影响，且有发展为侵袭性葡萄胎或绒毛膜癌的风险。
我们收集了在十年期间（2000年至2009年）转诊至我科的完全性葡萄胎病例。我们将展示研究结果，强调诊断、治疗及病情演变的方式，并进行文献综述。
在本研究期间，我们共确诊254例完全性葡萄胎，记录了57987例分娩和1627例流产。其发病率为妊娠总数的0.43%。我们患者的平均年龄为25岁（16至55岁）。观察到20岁以下女性（相对风险×6.8）和40岁以上女性（相对风险×15）的相对风险大幅增加。初产妇和经产妇各占队列的52.3%。85%的患者来自社会经济地位较低的农业环境。子宫出血是最常见症状，占93.7%。18.5%的患者出现中毒综合征。体格检查显示，85%的病例子宫大小明显增大，25%的病例伴有子宫旁肿块。所有病例均通过超声检查怀疑诊断，并伴有血浆β-人绒毛膜促性腺激素（βhCG）水平升高。所有病例均经组织学确诊。所有病例均采用宫内吸刮术治疗。25例患者（9.4%）记录有完全性葡萄胎复发。6.3%的病例观察到肿瘤进展。所有患者经化疗后均病情缓解。
完全性葡萄胎在摩洛哥仍是一个公共卫生问题，其发病率处于最高水平之一。实际上，本研究人群社会经济地位最低，通常被视为高危人群。该人群易受恶劣天气影响，导致新鲜农产品损失。极端年龄和产次也是文献中描述的风险因素。早期诊断、适当治疗以及对葡萄胎妊娠的监测必不可少。尽管初始条件不利，但我们的研究表明及时干预和持续护理可显著降低葡萄胎的发病率。
