The impact of pre-evacuation ultrasound examination in histologically confirmed hydatidiform mole in missed abortion
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RESEARCH ARTICLE
Open Access
The impact of pre-evacuation ultrasound examination in histologically confirmed hydatidiform mole in missed abortion Yunhui Tang1, Chenqi Zhu1, Chen Zhu1, Feng Liang2, Arier Lee3, Xiaoying Yao1* and Qi Chen4
Abstract Background: Early detecting hydatidiform mole in missed abortion is challenge. In this retrospective observational study, we analysed the sensitivity of detecting hydatidiform mole by pre-evacuation ultrasound examination or naked eye after surgical uterine evacuation in missed abortion. Methods: Data on 577 cases with histologically confirmed hydatidiform mole were collected over a 10-year period and analysed. Data included serum β-hCG level before surgical evacuation, the ultrasound examination findings, histology findings and naked eye findings. In addition, serum β-hCG level on 2398 cases without hydatidiform mole was also collected. Results: The median maternal age was 29 (range, 17–53) years and the range of gestational age was 6 to 12 weeks. The sensitivity of detecting hydatidiform mole by ultrasound examination or by naked eye was 25% or 60% respectively. This sensitivity was not increased by the combination of ultrasound and naked eye. There was no difference in the sensitivity of detecting subtypes of hydatidiform mole. The higher β-hCG level was seen in cases with hydatidiform mole, compared to cases without hydatidiform mole. However, there was a lot of overlap in the distributions of β-hCG between the two groups. Conclusions: In this study, we found lower sensitivity of detecting hydatidiform mole by ultrasound in missed abortion. βhCG level was higher in hydatidiform mole than in non- hydatidiform mole in missed abortion. Although higher sensitivity of detecting hydatidiform mole is seen by naked eye (60%), in order to minimise missed opportunity of detecting hydatidiform mole, our study suggests that routine histopathological examination is necessary in missed abortion. Keywords: Hydatidiform mole, Ultrasound, β-hCG, Complete hydatidiform mole, Partial hydatidiform mole
Background Hydatidiform mole is one of the most common complications of gestational trophoblastic diseases (GTD), which affects 0.6–1.1 per 1000 pregnancies [1]. Asia including China has a higher incidence of this disease [2], and we have recently reported that the cases of hydatidiform mole were significantly increased in China in the * Correspondence: [email protected]; [email protected] 1 Department of Family Planning, The Hospital of Obstetrics & Gynaecology, Fudan University, 419 Fangxie Road, Shanghai, China Full list of author information is available at the end of the article
last decade [3]. Although more than 80% of hydatidiform mole has spontaneous remission, 10 to 15% of cases may develop into invasive moles and 2–3% of cases may develop into choriocarcinoma. In addition, women with previous hydatidiform mole have an increased risk of developing a second hydatidiform mole in the next pregnancy [4]. Therefore, hydatidiform mole needs to be closely followed up in clinical
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