Early Pregnancy and Gynaecology Assessment Unit, University College Hospitals London (UCLH), Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK.
Early Pregnancy and Gynaecology Assessment Unit, University College Hospitals London (UCLH), Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, UK.
Placenta. 2018 Feb;62:28-33. doi: 10.1016/j.placenta.2017.12.008. Epub 2017 Dec 16.
The majority of complete hydatidiform moles (CHM) are detected on ultrasound examination by the end of the first trimester when they present as multiple sonolucent cysts. To better understand the pathophysiology of this unique placental pathology and improve its prenatal diagnosis and management we have reviewed the ultrasound features of CHM before the appearance of cystic changes.
We searched our database to identify all women diagnosed with a complete hydatidiform mole confirmed by histopathology who had an ultrasound examination before 9 weeks' gestation. We reviewed their ultrasound reports and all the corresponding images.
The study group included 39 women with a positive pregnancy test and vaginal bleeding, 36 of whom had at least two ultrasound examinations before 9 weeks' gestation. At the first scan (mean gestation age 7 + 1 weeks; SD 1.1), 29 out 39 (74.4%) of CHM presented as a heterogeneous hyperechogenic mass with or without gestational sac and the remaining ten (25.6%) cases as a regular 4-week gestational sac. Cystic molar changes became apparent from the end of the second month of gestation.
The development of a CHM follows a well-defined pattern starting with a macroscopically normal gestation sac at 4 weeks, which transforms into a polypoid mass between 5 and 7 weeks of gestation. The hydropic changes of the villous tissue is progressive and rarely visible in utero on ultrasound before 8 weeks of gestation. These findings should allow an earlier diagnosis and assist in the management counselling of women with CHM.
大多数完全性葡萄胎（CHM）在孕早期末通过超声检查发现，此时表现为多个囊状无回声区。为了更好地了解这种独特的胎盘病理学的病理生理学，并提高其产前诊断和管理水平，我们回顾了在出现囊性改变之前 CHM 的超声特征。
我们搜索了数据库，以确定所有通过组织病理学证实为完全性葡萄胎的女性，这些女性在 9 周妊娠前进行了超声检查。我们回顾了她们的超声报告和所有相应的图像。
研究组包括 39 例因妊娠试验阳性和阴道出血而就诊的女性，其中 36 例至少在 9 周妊娠前进行了两次超声检查。在第一次扫描（平均孕龄 7+1 周；SD 1.1）时，39 例 CHM 中有 29 例（74.4%）表现为不均质高回声肿块，有或无孕囊，其余 10 例（25.6%）表现为规则的 4 周孕囊。囊性葡萄胎改变从妊娠第二个月末开始显现。
CHM 的发展遵循一个明确的模式，从 4 周时的宏观正常孕囊开始，在 5 至 7 周妊娠时转变为息肉状肿块。绒毛组织的水肿变化是渐进的，在 8 周妊娠前的超声检查中很少能在宫内看到。这些发现可以帮助更早地诊断，并为 CHM 患者的管理咨询提供帮助。
