Öz
Twin pregnancy with complete hydatidiform and and coexistent fetus is a raresituation. Management of suchcases is always problematic because the possibility of fetal survival should always beweig hedagainst the risk of complications of molarpregnancy. A 36-year-old woman presented to our center with mildvaginal bleeding on 16. week of pregnancy. Obstetric ultrasound examination revealed a twin pregnancy with complete hydatidiform mole and acoexisting healthy fetus. Initialmaternal serum beta human chorionic gonadotropin level was431482mIU/mL. Our patient optedtermination of pregnancy and shedeveloped an attack of severe vaginal bleeding there forea hysterotomy wasperformed. Twin pregnancy with complete hydatidiform mole represents a matter of controversy. We suggest that conservative approach should be considered when evertertiary care services and strict observation are available.
Anahtar Kelimeler
Hydatiform mole twin pregnancy gestational trophoblastic neoplasia
Kaynakça
- Altieri A, Franceschi S, Ferlay J, Smith J, La Vecchia C.Epidemio- logyandetiology of gestation altrofoblastic disseases. Lancet Oncol 2003;4:670– 8.
- Matsui H, Sekiya S, Hando T, Wake N, Tomoda Y. Hydatidiform mole coexistent with a twin live fetus: a national collaborative study in Japan. Hum Reprod 2000; 15:608– 11.
- Montes– de– Oca– Valero F, Macara L, Shaker A. Twin pregnancy with a complete hydatidiform mole and coexisting fetus following invitrofertili- zation. Hum Reprod 1999; 14:2905– 7.
- Steller MA, Genest DR, Bernstein MR, Lage JM, Goldstein DP, Berkowitz RS. Clinical features of multiple conception with partialor complete molar pregnancy and coexisting fetuses. J Reprod Med 1994; 39:147– 154.
- Vaisbuch E, Ben– Arie A, Dgani R, Perlman S, Sokolovsky N, Hagay Z. Twin pregnancy consisting of a complete hydatidiform mole and co– existentfetus: report of two cases and review of literature. Gynecol Oncol 2005;98:19– 23.
- Piura B, Rabinovich A, Hershkovitz R, Maor E, Mazor M. Twin pregnancy with a complete hydatidiform mole and surviving co– existent fetus. Arch Gynecol Obstet 2008;278:377– 82.
- Vassilakos P, Riotton G, Kajii T. Hydatidiform mole: two entities. Am J Obstet Gynecol1977;127:167– 70.
- Wee L, Jauniaux E. Prenatal diagnosis and management of twin preg- nancies complicatedby a co– existing molarpregnancy. Prenat Diagn 2005;25:772– 6.
- Vejerslev LO, Sunde L, Hansen BF, Larsen JK, Christensen IJ, Larsen G. Hydatidiform mole and fetus with normal karyotype: support of a sepa- rateentity. Obstet Gynecol 1991;77:868– 74.
- Ishii J, Iitsuka Y, Takano H, Matsui H, Osada H, Sekiya S. Genetic diffe- rentiation of complete hydatidiform moles coexisting with normal fetus esbyshort tandem repeat– derived deoxyribonucleicacid polymorphism analysis. Am J Obstet Gynecol 1998;179:628– 34.
- Jun SY, Ro JY, Kim KR. p57kip2 is useful in the classiŞcation and diffe- rential diagnosis of complete and partial hydatidiform moles. Histopatho- logy 2003; 43:17–25.
- Massardier J, Golfier F, Journet D, Frappart L, Zalaquett M, SchottAM,et al.Twin pregnancy with complete hydatidiform mole and coexistent fetus: obstetric alandoncological out comes in a series of 14 cases. Eur J Obs- tet Gynecol Reprod Biol 2009;143:84– 7.
- Sebire NJ, Foskett M, Paradinas FJ,Fisher RA, Francis RJ, Short D, et al. Outcome of twin pregnancies with complete hydatidiform mole and healthyco– twin. Lancet 2002;359:2165–6.
- Jacobs PA, Szulman AH, Funkhouser J, Matsuura JS, Wilson CC. Hu- mantriploidy: relation ship between parentalorigin of the additional haplo- id complement and development of partial hydatidiform mole. Ann Hum Genet 1982; 46:223– 31.
- Jauniaux E. Partial moles: frompostnatalto prenatal diagnosis. Placenta 1999; 20: 379–88.
Öz
Kompletmol ve canlı fetusun birlikte bulunduğu ikiz gebelik KMCFG klinikte çok nadir karşılaşılan bir durumdur. KMCFG tanısı sonrasında gebeliğin yönetimi halen tartışmalı bir konu olmaya devam etmektedir.Vaka takdimimizde KMCFG olgusunun yönetiminin tartışılması amaçlanmıştır. Biz bu olgu sunumunda, birinci trimester boyunca abortusimminens ve subkoryonik kanama tanılarıyla takip edilen vetanısı16.haftada konulan bir KMCFG vakasını ele aldık.Vakamızda konservatif yaklaşım seçeneği düşünülmüş ve aile ayrıntılı bilgilendirilmiştir ancak aile isteği doğrultusunda ve hastanın vajinal kanaması olması nedeniyle gebelik histerotomi ile sonlandırılmıştır. KMCFG, ciddi maternal ve fetal komplikasyonlar ile birlikteliği olan ve pratikte ikilem yaratan bir durumdur. Aileye hastalığın muhtemel maternal ve fetal komplikasyonları anlatılmalı konservatif yaklaşım ve gebeliğin terminasyonu seçenekleri sunulmalıdır.Konservatif yaklaşım seçilen vakalar mutlaka perinatoloji ve onkoloji klinikleri olan merkezler tarafından takip edilmelidir.
Anahtar Kelimeler
Molhidatiform ikiz gebelik gestasyonel trofoblastik hastalık
Kaynakça
- Altieri A, Franceschi S, Ferlay J, Smith J, La Vecchia C.Epidemio- logyandetiology of gestation altrofoblastic disseases. Lancet Oncol 2003;4:670– 8.
- Matsui H, Sekiya S, Hando T, Wake N, Tomoda Y. Hydatidiform mole coexistent with a twin live fetus: a national collaborative study in Japan. Hum Reprod 2000; 15:608– 11.
- Montes– de– Oca– Valero F, Macara L, Shaker A. Twin pregnancy with a complete hydatidiform mole and coexisting fetus following invitrofertili- zation. Hum Reprod 1999; 14:2905– 7.
- Steller MA, Genest DR, Bernstein MR, Lage JM, Goldstein DP, Berkowitz RS. Clinical features of multiple conception with partialor complete molar pregnancy and coexisting fetuses. J Reprod Med 1994; 39:147– 154.
- Vaisbuch E, Ben– Arie A, Dgani R, Perlman S, Sokolovsky N, Hagay Z. Twin pregnancy consisting of a complete hydatidiform mole and co– existentfetus: report of two cases and review of literature. Gynecol Oncol 2005;98:19– 23.
- Piura B, Rabinovich A, Hershkovitz R, Maor E, Mazor M. Twin pregnancy with a complete hydatidiform mole and surviving co– existent fetus. Arch Gynecol Obstet 2008;278:377– 82.
- Vassilakos P, Riotton G, Kajii T. Hydatidiform mole: two entities. Am J Obstet Gynecol1977;127:167– 70.
- Wee L, Jauniaux E. Prenatal diagnosis and management of twin preg- nancies complicatedby a co– existing molarpregnancy. Prenat Diagn 2005;25:772– 6.
- Vejerslev LO, Sunde L, Hansen BF, Larsen JK, Christensen IJ, Larsen G. Hydatidiform mole and fetus with normal karyotype: support of a sepa- rateentity. Obstet Gynecol 1991;77:868– 74.
- Ishii J, Iitsuka Y, Takano H, Matsui H, Osada H, Sekiya S. Genetic diffe- rentiation of complete hydatidiform moles coexisting with normal fetus esbyshort tandem repeat– derived deoxyribonucleicacid polymorphism analysis. Am J Obstet Gynecol 1998;179:628– 34.
- Jun SY, Ro JY, Kim KR. p57kip2 is useful in the classiŞcation and diffe- rential diagnosis of complete and partial hydatidiform moles. Histopatho- logy 2003; 43:17–25.
- Massardier J, Golfier F, Journet D, Frappart L, Zalaquett M, SchottAM,et al.Twin pregnancy with complete hydatidiform mole and coexistent fetus: obstetric alandoncological out comes in a series of 14 cases. Eur J Obs- tet Gynecol Reprod Biol 2009;143:84– 7.
- Sebire NJ, Foskett M, Paradinas FJ,Fisher RA, Francis RJ, Short D, et al. Outcome of twin pregnancies with complete hydatidiform mole and healthyco– twin. Lancet 2002;359:2165–6.
- Jacobs PA, Szulman AH, Funkhouser J, Matsuura JS, Wilson CC. Hu- mantriploidy: relation ship between parentalorigin of the additional haplo- id complement and development of partial hydatidiform mole. Ann Hum Genet 1982; 46:223– 31.
- Jauniaux E. Partial moles: frompostnatalto prenatal diagnosis. Placenta 1999; 20: 379–88.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Case Report |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2016 |
| Yayımlandığı Sayı | Yıl 2016 Özel Sayı |