Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy
Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy
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DOI：
10.1016/s1470-0328(02)02988-9
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发表时间：
2003-01-01
影响因子：
5.8
通讯作者：
Newlands, ES
中科院分区：
文献类型：
--
作者：
Sebire, NJ;Fisher, RA;Newlands, ES
目的探讨组织学证实完全或部分葡萄胎后的妊娠结局，包括重复妊娠率。设计对妊娠滋养细胞疾病登记的大型跨区域数据库进行回顾性分析。设置跨区域滋养细胞疾病单位，伦敦。样本1992年至1998年间登记的怀孕期间患有完全或部分葡萄胎的妇女。方法对所有经组织学诊断为完全或部分葡萄胎的患者，采用比例法比较两组间妊娠情况。主要结局指标：部分或完全痣亚型妊娠结局，特别是关于后续磨牙妊娠的风险。结果在2578例完全痣中，27例（1.9%）发生葡萄胎影响妊娠，其中完全痣22例（81%），部分痣5例（19%）。在2627例部分痣中，25例（1.7%）妊娠也是磨牙，其中17例（68%）为部分痣，8例（32%）为完全痣。磨牙妊娠的总体复发风险为1.8%(1 / 55)，与背景风险相比增加了20倍。在27例重复完全痣的病例中，3例进一步完全痣，表明两次完全痣后的复发风险约为10%。以前有完全或部分葡萄胎的病例与未选择的产科人群的妊娠结局没有其他显著差异。结论：经组织学证实患有完全或部分葡萄胎的妊娠妇女应被告知，在随后的妊娠中再次发生葡萄胎的风险约为1 / 60，如果发生这种情况，大多数病例将与前一次妊娠相同类型的葡萄胎。然而，在磨牙受孕后怀孕的妇女中，约有98%不会再出现葡萄胎，而且这些妊娠不会增加其他产科并发症的风险。
Objective To determine pregnancy outcome, including the rate of repeat molar pregnancy, following histologically confirmed complete or partial hydatidiform mole.Design Retrospective review of a large supraregional database of registrations for gestational trophoblastic disease.Setting Supraregional Trophoblastic Disease Unit, London.Sample Women with pregnancies affected by complete or partial hydatidiform mole registered between 1992 and 1998.Methods All patients with a diagnosis of histologically confirmed complete or partial hydatidiform mole were identified and data on subsequent pregnancies compared between groups using comparison of proportion test.Main outcome measures Pregnancy outcome by partial or complete mole subtype, with particular regard to risk of subsequent molar pregnancy.Results Of 2578 complete moles, the subsequent pregnancy was affected by hydatidiform mole in 27 (1.9%) cases, including 22 (81%) complete moles and 5 (19%) partial moles. Of 2627 partial moles, the subsequent pregnancy was also molar in 25 (1.7%) cases, including 17 (68%) partial moles and 8 (32%) complete moles. Overall recurrence risk for molar pregnancy was 1.8% (1 in 55), or a 20-fold increase compared with the background risk. Of 27 cases with repeat complete moles, three had further complete moles, suggesting the recurrence risk following two previous complete moles is approximately 10%. There were no other significant differences in pregnancy outcome between cases with previous complete or partial hydatidiform mole and that expected in an unselected obstetric population.Conclusions Women having a pregnancy affected by a histologically confirmed complete or partial hydatidiform mole may be counselled that the risk of repeat mole in a subsequent pregnancy is about 1 in 60 and if this were to occur, the majority of cases will be of the same type of mole as the preceding pregnancy. However, >98% of women who become pregnant following a molar conception will not have a further hydatidiform mole and these pregnancies are at no increased risk of other obstetric complications.