Fishman D A, Padilla L A, Keh P, Cohen L, Frederiksen M, Lurain J R
John I. Brewer Trophoblastic Disease Center and the Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois, USA.
Obstet Gynecol. 1998 Apr;91(4):546-50. doi: 10.1016/s0029-7844(97)00720-5.
To report the clinical features, management, and outcome of twin pregnancies consisting of a complete hydatidiform mole and a coexisting normal fetus.
Between 1966 and 1997, seven women with complete hydatidiform mole and coexisting normal fetus were treated at the John I. Brewer Trophoblastic Disease Center of Northwestern University Medical School. Clinical features, including presenting symptoms, gestational dates, hCG levels, and complications, as well as route of delivery or evacuation, pregnancy outcome, genetic analysis, and need for chemotherapy were assessed.
Four women required uterine evacuation before 20 weeks' gestation because of vaginal bleeding or medical complications, one woman required an emergency hysterotomy because of hemorrhage at 24 weeks, and two women delivered normal, viable infants at 26 and 34 weeks. The pathologic diagnosis of complete hydatidiform mole was confirmed in each case and the chromosome complement was 46,XX in all molar gestations. Four of seven women required chemotherapy for treatment of nonmetastatic gestational trophoblastic tumors, including both women who delivered viable infants and two of the five women whose pregnancies were evacuated before 24 weeks' gestation. All four patients were treated with five to seven cycles of a 5-day methotrexate regimen and achieved complete remission.
Patients with a twin pregnancy consisting of a complete mole and a normal fetus are at increased risk for hemorrhage and medical complications, as well as the development of persistent gestational trophoblastic tumor.
报告由完全性葡萄胎和并存的正常胎儿组成的双胎妊娠的临床特征、处理方法及结局。
1966年至1997年间，西北大学医学院约翰·I·布鲁尔滋养细胞疾病中心治疗了7例完全性葡萄胎合并正常胎儿的患者。评估其临床特征，包括出现的症状、孕周、人绒毛膜促性腺激素（hCG）水平及并发症，以及分娩或清宫途径、妊娠结局、基因分析和化疗需求。
4例患者因阴道出血或内科并发症在妊娠20周前需要清宫，1例患者因24周时出血需要急诊子宫切开术，2例患者分别在26周和34周分娩出正常活婴。每例均确诊为完全性葡萄胎，所有葡萄胎妊娠的染色体核型均为46,XX。7例患者中有4例因治疗非转移性妊娠滋养细胞肿瘤需要化疗，包括2例分娩活婴的患者和5例妊娠在24周前清宫的患者中的2例。所有4例患者均接受了5至7个周期的5天甲氨蝶呤治疗方案并实现完全缓解。
由完全性葡萄胎和正常胎儿组成的双胎妊娠患者发生出血、内科并发症以及持续性妊娠滋养细胞肿瘤的风险增加。
