Irani Roxanna A, Holliman Kerry, Debbink Michelle, Day Lori, Mehlhaff Krista, Gill Lisa, Heuser Cara, Kachikis Alisa, Strickland Kristine, Tureson Justin, Shank Jessica, Pilliod Rachel, Iyer Chitra, Han Christina S
Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal Fetal Medicine, University of California San Francisco, San Francisco, California.
Austin Maternal-Fetal Medicine, Austin, Texas.
AJP Rep. 2021 Oct 25;12(1):e96-e107. doi: 10.1055/a-1678-3563. eCollection 2022 Jan.
The objective of the study was to review the obstetric outcomes of complete hydatidiform molar pregnancies with a coexisting fetus (CHMCF), a rare clinical entity that is not well described. We performed a retrospective case series with pathology-confirmed HMCF. The cases were collected via solicitation through a private maternal-fetal medicine physician group on social media. Each contributing institution from across the United States ( = 9) obtained written informed consent from the patients directly, obtained institutional data transfer agreements as required, and transmitted the data using a Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant modality. Data collected included maternal, fetal/genetic, placental, and delivery characteristics. For descriptive analysis, continuous variables were reported as median with standard deviation and range. Nine institutions contributed to the 14 cases collected. Nine (64%) cases of CHMCF were a product of assisted reproductive technology and one case was trizygotic. The median gestational age at diagnosis was 12 weeks and 2 days (9 weeks-19 weeks and 4 days), and over half were diagnosed in the first trimester. The median human chorionic gonadotropin (hCG) at diagnosis was 355,494 mIU/mL (49,770-700,486 mIU/mL). Placental mass size universally enlarged over the surveillance period. When invasive testing was performed, insufficient sample or no growth was noted in 40% of the sampled cases. Antenatal complications occurred in all delivered patients, with postpartum hemorrhage (71%) and hypertensive disorders of pregnancy (29%) being the most frequent outcomes. Delivery outcomes were variable. Four patients developed gestational trophoblastic neoplasia. This series is the largest report of obstetric outcomes for CHMCF to date and highlights the need to counsel patients about the severe maternal and fetal complications in continuing pregnancies, including progression to gestational trophoblastic neoplastic disease. CHMCF is a rare obstetric complication and may be associated with the use of assisted reproductive technology.Universally, patients with CHMCF who elected to manage expectantly developed antenatal complications.The risk of developing gestational trophoblastic neoplasia after CHMCF is high, and termination of the pregnancy did not decrease this risk.
本研究的目的是回顾并存胎儿的完全性葡萄胎妊娠（CHMCF）的产科结局，这是一种罕见的临床情况，目前尚无详细描述。
我们进行了一项经病理证实的HMCF回顾性病例系列研究。这些病例是通过在社交媒体上向一个私人母胎医学医生团队征集而收集的。来自美国各地的每个参与机构（n = 9）直接获得了患者的书面知情同意书，按要求获得了机构数据传输协议，并使用符合1996年《健康保险流通与责任法案》（HIPAA）的方式传输数据。收集的数据包括母亲、胎儿/遗传、胎盘和分娩特征。对于描述性分析，连续变量报告为中位数及标准差和范围。
九个机构为收集到的14例病例做出了贡献。9例（64%）CHMCF病例是辅助生殖技术的产物，1例为三受精卵。诊断时的中位孕周为12周零2天（9周 - 19周零4天），超过一半在孕早期被诊断出来。诊断时的中位人绒毛膜促性腺激素（hCG）为355,494 mIU/mL（49,770 - 700,486 mIU/mL）。在监测期间，胎盘质量大小普遍增大。进行侵入性检测时，40%的采样病例中样本不足或无生长。所有分娩患者均出现产前并发症，产后出血（71%）和妊娠期高血压疾病（29%）是最常见的结局。分娩结局各不相同。4例患者发生了妊娠滋养细胞肿瘤。
该系列是迄今为止关于CHMCF产科结局的最大规模报告，强调了需要向患者咨询继续妊娠时严重的母婴并发症，包括进展为妊娠滋养细胞肿瘤疾病。CHMCF是一种罕见的产科并发症，可能与辅助生殖技术的使用有关。普遍而言，选择期待管理的CHMCF患者会出现产前并发症。CHMCF后发生妊娠滋养细胞肿瘤的风险很高，终止妊娠并不能降低这种风险。
