European Journal of Biological Sciences 3 (4): 102-104, 2011ISSN 2079-2085© IDOSI Publications, 2011

Corresponding Author: Chandra Madhudas, Department of Obstetrics and Gynaecology, Liaquat University of Medical andHealth Sciences, Jamshoro, Sindh, Pakistan.

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Analysis of Patients with Recurrent Molar Pregnancy in Tertiary Care Hospital

Chandra Madhudas, Farkhunda Khursheed and Pushpa Srichand

Department of Obstetrics and Gynaecology, Liaquat University of Medical and Health Sciences Jmahsoro, Sindh, Pakistan

Abstract: This descriptive study was conducted on patients for determination of the frequency and risk factorsfor recurrent molar pregnancy at Department of Obstetrics and Gynecology Unit-II, Liaquat University HospitalHyderabad Sindh during Jan 2005 to Dec 2008. A retrospective review of patients admitted with molarpregnancies was carried out. Patients were scrutinized by history, clinical examination and investigations.Those with molar pregnancy more than once were considered as recurrent molar. A pre-designed proforma wasfilled to analyze risk factors. Out of 120 complete moles, subsequent pregnancies were affected by recurrentcomplete hydatidiform moles in five patients giving a frequency of 4.16%. All five had no live issue. Threepatients out of five had positive family history of recurrent molar and cousin marriage while in two patientsthere was no positive family history of molar or cousin marriage. Strong family history and consignors marriageswere the risk factors for recurrent molar pregnancy.

Key words: Hydatidiform moles Recurrent molar pregnancy Genetic predisposition

INTRODUCTION is compromised and there are limited treatment options.

The world health organization has classified into two groups. Those patients with positive familygestational trophoblastic diseases into two pre-malignant history of recurrent complete moles and consanguinitydiseases termed complete hydatidiform mole (CHM) and usually genetically are Biparental as proved by manypartial hydatidiform mole (PHM) and three malignant studies [5-7]. Specific gene defect in these families has notdisorders, invasive moles, gestational choriocarcinoma been identified; genetic mapping has shown that in mostand placental site trophoblastic tumors [1]. Hydatidiform families the gene responsible is located on a 1.1mb regionmoles can be classified on the basis of histological on chromosome 19 q.13.4. Mutation in this gene isexamination and genetic origins as complete or partial responsible for abnormal ovum leading to Biparentalhydatidiform moles. Partial hydatidiform moles are CHM, this is inherited as autosomal recessive disorder [8].genetically nearly all triploid with two paternal and one Patients with personal history of recurrent moles withoutmaternal chromosome sets [2]. Triploid due to two sets of positive family history of recurrent moles andmaternal chromosome does not become PHM. CHM are consanguinity have usually androgenetic completegenerally diploid and androgenetic in origin, all 46 hydatidiform moles [9]. But, rarely things can occur vicechromosomes being derived from the father. They may be versa. This study was carried out to see the prevalence ofmonospermic, arising by fertilization of an enucleate egg recurrent molar pregnancy in our patient and see whatby a single spermatozoa which then doubles or dispermic diagnostic and treatment options are available in ourby fertilization of an enucleate egg by two spermatozoa. setup, where facility of molecular genetic study is notRarely CHM can be Biparental in origin having available.chromosome complement from both partners [3].

Recurrence is rare complication of hydatidiform MATERIALS AND METHODSmoles, although it only occurs in 2% [4] of cases, butidentification of genetic origin of repetitive hydatidiform This descriptive study was conducted at Gynaemoles is important since it is related with recurrence in Unit-II, LUMHS during Jan 2005 to Dec 2008.future, there is increase risk of malignancy, future fertility Departmental approval for the study was obtained. A

Patients with recurrent hydatidiform moles can be divided

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retrospective review of case records of patients admitted complete hydatidiform moles was reported. In our study,during study period was made. Data was collected in a three patients out of five had strong family history ofredesigned proforma. recurrent molar pregnancies and consanguinity. Familial

All patients presented with complete hydatidiform recurrent CHM are usually Biparental as proved by recentmoles and those who presented with recurrent complete genetic study of two families in which several sisters hadhydatidiform moles with no normal conception in between one or more CHM [5] in one family in particular there waspregnancies were included in study. Patients presented a strong history of consanguinity as in three of ourwith partial hydatidiform moles and with hydropic patients. Genetic origin of complete hydatidiform moles inabortions were excluded from study. The data was entered our study was not examined, the reason being that it isand analyzed by SPSS (Version 10). expensive investigation and our patients could not afford

RESULTS Biparental complete hydatidiform mole. Our two patients

During the study period, out of 120 patients with without a live issue, but no family history of molar orhydatidiform mole while five presented with recurrent consanguinity; this may be androgenic CHM as provedcomplete molar pregnancies giving prevalence of 4.16%. by JJ vander smegt in genetic study in two of his patientsThe diagnosis of hydatidiform mole was confirmed on with history of recurrent molar pregnancy but no familyhistopathology. The relevant detail of every case is history of molar and consanguinity.presented in Table 1. Recurrent CHM has significant clinic pathological

DISCUSSION reproductive performance. Risk of persistent trophoblastic

Incidence of CHM is variable, complicating 1/1000 to is 22% after first molar and 50% after 2 molar1/2000 pregnancies in the United States and 1/125 in some pregnancies [17]. So for genetic counseling and treatmenthigh incidence areas in Southeast Asia. In the Middle options are concerned making the distinction betweenEast, where many familial cases of highly recurrent BiCHM and AnCHM is important, women having BiCHMBiCHM originate, the incidence is about 1/500 [10]. The have close to 100% risk of adverse pregnancy out come,incidence of recurrence after one CHM ranging from while women with AnCHM have reasonable chance of0.6- 2.3% and 15 - 28% after two CHM [11]. Prevalence of having healthy children. Genetic aspect in our study wasrecurrent complete hydatidiform molar pregnancy in the not possible, but from history and review of literature wecurrent study was 4.16% which is more then studies from can assume that three of our patients may have BiCHM,different part of world [12, 13]. so for fertility is concerned option for them is either

In Pakistan, though the studies on trophoblastic sterilization or ovum donation. While our two patientsdisease [14-16] are carried out, but there is no study on may have AnCHM and in that case there is number ofrecurrent molar pregnancy to report incidence of this options like changing the partner, IVF with donor sperm,condition. The high prevalence of recurrent complete ICSI combined with pre-implantation genetic diagnosishydatidiform moles in current study may be either by (PGD). Our study has proved that prevalence of recurrentchance or may be that we only included cases in which molar pregnancies is more in our part of world as comparehistopathology conformed CHM excluding partial to other part of world; we there fore propose that in futuremoles or hydropic abortions. This is also fact that we fall cases of woman with two or more CHM should bein Middle East whereas maximum number of recurrent investigated by molecular techniques.

it, we can assume that three of these patients may had

had three consecutive complete molar pregnancies

implication including risk of malignant squeal and poor

disease is similar both in BiCHM and AnCHM. This risknd

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Table 1: Patients with recurrent complete molar pregnancies

No: of Cases Age (years) Gestational age (weeks) Gravida Para Family history / cousin marriage Past history

01 30 12 06 0+5 +ve +ve

02 35 08 08 0+7 +ve +ve

03 30 10 05 0+4 -ve +ve

04 26 12 04 0+3 +ve +ve

05 24 08 03 0+2 -ve +ve

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CONCLUSION 8. Fisher, R.A., M.D. Hodges and E.S. Newlands, 2004.

Keeping in front the result of current study, it looks Reprod Med., 49(8): 595-601.that recurrent molar pregnancy is being ignored in our 9. Van Der Smagt, J.J., E. Scheenjes, J.A. Kremer,part of world. As it is related to childlessness, F.A. Hennekam and R.A. Fisher, 2006. Heterogeneitypsychological trauma and increase chance of malignancy in the origin of recurrent complete hydatidiformin future. It is recommended that patient who present with moles: not all women with multiple molar pregnanciesrecurrent molar pregnancy should be offered genetic have biparental moles. BJOG, 113(6): 725-8.testing to reach the definite diagnosis so that couple can 10. Van Den Veyver, I.B. and T.K. Al-Hussaini, 2006.be helped out to plain future pregnancy. Biparental hydatidiform moles: a maternal effect

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