Biscaro Andressa, Silveira Sheila Koettker, Locks Giovani de Figueiredo, Mileo Lívia Ribeiro, da Silva Júnior João Péricles, Pretto Péricles
Serviço de Ginecologia e Obstetrícia, Maternidade Carmela Dutra - Florianópolis (SC), Brasil.
Rev Bras Ginecol Obstet. 2012 Jun;34(6):254-8.
To determine the frequency of hydatiform mole in tissues obtained by curettage.
A cross-sectional, prospective and descriptive conducted on patients who underwent curretage due to a diagnosis of abortion or hydatiform mole whose material was sent for pathological examination. We excluded women who did not accept to participate and refused to sign the free informed consent form. We studied the following variables: pathological findings, age, race, number of pregnancies and previous abortions, gestational age at diagnosis, quantitative serum beta fraction of human chorionic gonadotropin and ultrasound findings. The data were compared to the to histological diagnosis, considered to be the gold standard. Data were stored and analyzed in Microsoft Excel(®) software and the Epi-Info program, version 6.0 (STATCALC) and the results are presented as frequency (percentage) or mean±standard deviation. The χ(2) test was used to determine the association between qualitative variables and the level of significance was set at p<0.005.
A total of 515 curettage procedures were performed, 446 of which comprised the sample. The frequency of hydatiform mole was 2.2% (ten cases). The mean age of the patients with a mole was 31±10 years, most patients were white and multiparous and had no history of previous abortions, but there was no significant association between these variables. The pregnancy loss occurred early in patients with and without a mole and the most common complaints in both groups were vaginal bleeding and cramps in the lower abdomen. Quantitative determination of human chorionic gonadotropin was performed in 422 cases (413 with and 9 without a hydatiform mole). The levels of the hormone were higher than 100,000 mIU/mL in 1.9% of the patients without a hydatiform mole and in 44.45% of the patients with the disease (p=0.00004). All patients with this hormonal level had an ultrasound suspicion of hydatiform mole and one of them also had a clinical suspicion. A total of 333 patients underwent ultrasound examination. Of the patients with sonographic findings suggestive of molar pregnancy, there was confirmation in five (41.7%) cases. The other seven (58.3%) were false positives. A significant association was found between ultrasound suspected molar pregnancy and disease confirmation by histopathological analysis (p=0.0001). In 50% of cases of hydatiform mole there was no suspicion of the disease according to clinical signs and symptoms, levels of beta fraction of human chorionic gonadotropin or sonographic findings.
The frequency of hydatidiform mole is low and the disease may not be suspected by clinical examination, ultrasonography or the serum level of the beta fraction of human chorionic gonadotropin, requiring pathological examination of tissue obtained by uterine evacuation for diagnosis.
确定刮宫获取组织中葡萄胎的发生率。
对因诊断为流产或葡萄胎而接受刮宫且其组织送检病理检查的患者进行一项横断面、前瞻性和描述性研究。我们排除了不接受参与且拒绝签署自由知情同意书的女性。我们研究了以下变量：病理结果、年龄、种族、妊娠次数和既往流产史、诊断时的孕周、血清人绒毛膜促性腺激素β亚基定量以及超声检查结果。将数据与被视为金标准的组织学诊断进行比较。数据在Microsoft Excel（®）软件、Epi-Info程序6.0版（STATCALC）中存储和分析，结果以频率（百分比）或均值±标准差表示。采用χ²检验确定定性变量之间的关联，显著性水平设定为p<0.005。
共进行了515例刮宫手术，其中446例纳入样本。葡萄胎的发生率为2.2%（10例）。葡萄胎患者的平均年龄为31±10岁，大多数患者为白人且为经产妇，既往无流产史，但这些变量之间无显著关联。有或无葡萄胎的患者均早期发生妊娠丢失，两组最常见的主诉均为阴道出血和下腹部痉挛。422例患者进行了人绒毛膜促性腺激素定量测定（413例有葡萄胎，9例无葡萄胎）。在无葡萄胎的患者中，1.9%的患者激素水平高于100,000 mIU/mL，而在患有该疾病的患者中这一比例为44.45%（p=0.00004）。所有激素水平达到此值的患者超声均怀疑为葡萄胎，其中1例临床也有怀疑。共有333例患者接受了超声检查。超声检查结果提示为葡萄胎妊娠的患者中，5例（41.7%）得到确诊。另外7例（58.3%）为假阳性。超声怀疑葡萄胎妊娠与组织病理学分析确诊疾病之间存在显著关联（p=0.0001）。在50%的葡萄胎病例中，根据临床症状和体征、人绒毛膜促性腺激素β亚基水平或超声检查结果未怀疑该疾病。
葡萄胎的发生率较低，临床检查、超声检查或血清人绒毛膜促性腺激素β亚基水平可能无法怀疑该疾病，需要对刮宫获取的组织进行病理检查以明确诊断。
