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Endocrine tumors in pregnancy
Published in Nadia Barghouthi, Jessica Perini, Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Incidence of partial molar pregnancy, however, is unknown.5 This is likely due to underdiagnosis secondary to lack of histology and karyotype analysis with spontaneous miscarriages and induced abortions.
Pregnancy, Delivery and Postpartum
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Katy Kuhrt, Kopal Singhal Agarwal, Chawan Baran, Rebecca Best, Maria Garcia de Frutos, Miranda Geddes-Barton, Laura Bridle, Black Benjamin
Molar pregnancies are categorised into partial and complete:Partial molar pregnancy – usually (90%) triploid in origin, with two sets of paternal haploid genes and one set of maternal haploid genes. Partial moles occur – in almost all cases, following dispermic fertilisation of an ovumComplete molar pregnancy – diploid and androgenic in origin, with no evidence of fetal tissue. Complete moles usually (75–80%) arise as a consequence of duplication of a single sperm following fertilisation of an ‘empty’ ovum.
Cervical Ectopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Methotrexate is an immunosuppressive and chemotherapeutic agent that is often used to treat a wide range of different malignancies; autoimmune diseases, such as rheumatoid arthritis and other inflammatory types of arthritis; and ectopic pregnancies. Common side effects include nausea, fatigue, fever, increased risk of infection, low white blood cell counts, and breakdown of the skin inside the mouth [21]. Other side effects may include liver disease, lung disease, lymphoma, and severe skin rashes [21]. People on long-term treatment should be regularly checked for side effects [21]. It is not safe to use during breastfeeding [21]. In patients with kidney problems, lower doses may be needed; it acts by blocking the body's use of folic acid [21]. During pregnancy, methotrexate is an abortifacient and is commonly used to terminate pregnancies during the early stages, generally in combination with misoprostol. As mentioned earlier, it is also used to treat ectopic pregnancies, provided the fallopian tube has not ruptured [21]. Methotrexate with dilatation and curettage is used to treat molar pregnancy.
Methotrexate induced peritonitis: diagnosis per exclusionem
Published in Journal of Obstetrics and Gynaecology, 2021
Raphaël Rienstra, Eva A.S. Koster, Catharina C.A.H. Janssen
A 26-year-old female with no relevant medical history was referred for suction curettage for her non-intact pregnancy. At the ultrasound examination there was suspicion of a complete molar pregnancy, as no amniotic sac nor embryo was visible. Her Beta-HCG level was 167620 IU/l. A suction curettage was performed and the diagnosis of a complete molar pregnancy was confirmed by histopathological and immunohistochemical examination. After curettage, beta-HCG declined, but after three weeks it rose again. Her chest X-ray and CT-abdomen showed no metastases. The patient was classified as low risk and started with methotrexate. The scheduled regimen consisted of 14-days courses until her beta-HCG levels would reach zero followed by two consolidation courses. The patient was scheduled to receive 1 mg/kg methotrexate on day 1-3-5-7. On day 2-4-6 she received folinic acid to decrease the toxic effects of methotrexate, followed by a break of seven days without medication. Around her last methotrexate injection in the second course she complained of a progressive epigastric pain (Figure 1).
Triplet pregnancy with complete mole
Published in Journal of Obstetrics and Gynaecology, 2021
Sujata Siwatch, Minakshi Rohilla, Vanita Jain, Radhika Srinivasan, Shalini Gainder, G. R. V. Prasad
The patient was counselled regarding the diagnostic dilemma, complications associated with possible molar pregnancy including bleeding, early termination of pregnancy, risk of metastasis and the need for subsequent chemotherapy in case of molar gestation and abnormal karyotype in the foetus in case of a partial mole. The options of an immediate termination of the pregnancy or conservative management with termination as required were discussed with her. The patient was very keen on continuing the pregnancy. She was planned to undergo an amniocentesis to assess the karyotype of the twins. A critical review of the ultrasound was done. The placenta of the live and seemingly normal twins was anterior and remained the same while the lower mass covering the os increased in size over the next few days. The separate presence of the normal placenta of the twins negated the diagnosis of placental mesenchymal dysplasia.
Thiol/Disulfide Homeostasis in Patients with Molar Pregnancies
Published in Fetal and Pediatric Pathology, 2020
Meryem Kuru Pekcan, Aytekin Tokmak, Nazli Topfedaisi Ozkan, Gulnur Ozaksit, Arzu Kosem, Ozcan Erel, Mutlu Meydanli
Molar pregnancy (MP) is a group of tumors [1] that was classified as gestational trophoblastic disease (GTD) [1]. MPs, also known as hydatidiform mole, are characterized by an abnormal chorionic villus derived by paternal genes, originating from the villous trophoblast [2]. They can be categorized as complete hydatidiform mole (CHM) or partial hydatidiform mole (PHM) based on their morphologic features and underlying genotype [3]. Most CHMs are 46 XX karyotype and caused by the fertilization of an ovum by 23 X haploid sperm, which then replicates its own chromosomes. CHMs generally have paternal chromosomes. PHMs are caused by fertilization of normal ovum with two spermatozoa [4]. The frequencies range from 10 to 0.7 per 1000 pregnancies depending on geographic differences [5]. Ethnic factors, genetic differences, and problems in data collection (in particular, data that originate from rural areas) might have resulted in those remarkable differences. MPs are also more common in pregnancies occurring in an early (<20 years) or late stage (>40 years) of a woman's reproductive life cycle. [6].