Retrospective Observational Study of Ultrasonography for Molar Pregnancy in Nangarhar, Afghanistan
Abstract
Introduction: The primary aims of this study were to establish what proportion of ultra-sonographic suspected molar pregnancies and to review the features of these scans to help identify criteria that may improve ultra-sonographic diagnosis. This was a retrospective observational study conducted in the Early Pregnancy in Nangarhar University Teaching Hospital over in 2-year period. Cases of ultrasonographically suspected to molar pregnancy or other gestational trophoblastic disease were identified. In addition, cases which were diagnosed on histopathology that were not suspected on ultrasound were also examined. In discrepant cases, the images were reviewed unblended by two senior sonographers. Statistical analysis for likelihood ratio and post-test probabilities was performed. There was a total of 18864 pregnancies during the study period seventy-two women had gestational trophoblastic disease suspected on ultrasound examination (1:262, 0.38%) 53/72 (73.6%) had histologically confirmed gestational trophoblastic disease, Sensitivity was 73.6% with an estimated specificity of 99.7%. 72 molar pregnancies were suspected on pre-op ultrasound; 43/72 of complete moles were suspected on pre-op ultrasound, compared with 16/72 of partial moles. On retrospective review of the pre-op ultrasound images, there were cases that could have been suspected prior to surgery. Detecting molar pregnancy by ultrasound remains a diagnostic challenge, particularly for partial moles. These data suggest that there has been an increase in both the predictive value and the sensitivity of ultrasound over time, with a high LR and post-test probability; however, the diagnostic criteria remain ill-defined and could be improved.
Downloads
References
2. Lybol C, Thomas CMG, Bulten J, et al. Increase in the incidence of gestational trophoblastic disease in The Netherlands. Gynecol Oncol 2011; 121: 334–338.
3. Ngan HY, Seckl MJ, Berkowitz RS, et al. Update on the diagnosis and management of gestational trophoblastic disease. Int J Gynaecol Obstet 2015; October(131 Suppl 2): S123 S126.
4. Donald I. Use of ultrasonics in diagnosis of abdominal swellings. Br Med J 1963; 2: 1154 1155.
5. Robinson DE, Garrett WJ and Kossoff G. The diagnosis of hydatidiform mole by ultrasound. Aust N Z J Obstet Gynaecol 1968; 8:74–78.
6. Donald I and Brown TG. Demonstration of tissue interfaces within the body by ultrasonic echo sounding. Br J Radiol 1961; 34: 539–546.
7. Eagles N, Sebire NJ, Short D, et al. Risk of recurrent molar pregnancies following complete and partial hydatidiform moles. Hum Reprod 2016; 31: 1379.
8. Fine C, Bundy AL, Berkowitz RS, et al. Sonographic diagnosis of partial hydatidiform mole. Obstet Gynecol 1989; 73: 414–418.
9. Lazarus E, Hulka C, Siewert B, et al. Sonographic appearance of early complete molar pregnancies. J Ultrasound Med 1999; 18: 589–594; quiz 95–96.
10. Shanbhogue AK, Lalwani N and Menias CO. Gestational trophoblastic disease. Radiol Clin N Am 2013; 51: 1023–1034.
11. Sebire NJ, Rees H, Paradinas F, Seckl M and Newlands E. The diagnostic implications of routine ultrasound examination in histologically confirmed early molar pregnancies. Ultrasound in Obstetrics and Gynecology 2001; 18: 662–665.
12. Johns J, Greenwold N, Buckley S, et al. A prospective study of ultrasound screening for molar pregnancies in missed miscarriages. Ultrasound Obstet Gynecol 2005; 25: 493–497.
13. Fowler DJ, Lindsay I, Seckl MJ and Sebire NJ. Routine preevacuation ultrasound diagnosis of hydatidiform mole: experience of more than 1000 cases from a regional referral center. Ultrasound in Obstetrics & Gynecology : The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology 2006; 27: 56–60.
14. Kirk E, Papageorghiou AT, Condous G, et al. The accuracy of first trimester ultrasound in the diagnosis of hydatidiform mole. Ultrasound Obstet Gynecol 2007; 29: 70–75.
15. Savage JL, Maturen KE, Mowers EL, et al. Sonographic diagnosis of partial versus complete molar pregnancy: a reappraisal. J Clin Ultrasound 2017; 45: 72–78.
16. Sebire NJ, Foskett M, Fisher RA, et al. Risk of partial and complete hydatidiform molar pregnancy in relation to maternal age. BJOG 2002; 109: 99–102.
17. Alsibiani SA. Value of histopathologic examination of uterine products after first-trimester miscarriage. Biomed Res Int 2014.
18. Jackie A. Ross, Alina Unipan, Jackie Clarke, Catherine Magee and Jemma Johns,Ultrasound diagnosis of molar pregnancy
19. Wang CM, Dixon PH, Decordova S, et al. Identificationof 13 novel NLRP7 mutations in 20 families with recurrent hydatidiform mole; missense mutations cluster in the leucine-rich region. J Med Genet 2009;46:569–75.
20. Deveault C, Qian JH, Chebaro W, et al. NLRP7 mutations in women with diploid androgenetic and triploid moles: a proposed mechanism for mole formation. Hum Mol Genet 2009;18:888–97.
21. Tidy JA, Hancock BW, Newlands ES. The management of gestational trophoblastic neoplasia. Royal College of Obstetricians and Gynaecologists (RCOG) clinical guideline No. 38. London: RCOG Press; 2004.
22. Seckl MJ, Gillmore R, Foskett M, et al. Routine terminations of pregnancy–should we screen for gestational trophoblastic neoplasia? Lancet 2004; 364:705–7.
23. Berezowsky J, Zbieranowski I, Demers J, et al. DNA ploidy of hydatidiform moles and nonmolar conceptuses: a study using flow and tissue section image cytometry. Mod Pathol 1995;8:775–81.
24. Fisher RA, Newlands ES. Gestational trophoblastic disease. Molecular and genetic studies. J Reprod Med 1998;43:87–97.
25. Castrillon DH, Sun D, Weremowicz S, et al. Discrimination of complete hydatidiform mole from its mimics by immunohistochemistry of the paternally imprinted gene product p57KIP2. Am J Surg Pathol 2001;25:1225–30.
26. Santos-Ramos R, Forney JP, Schwarz BE. Sonographic findings and clinical correlations in molar
pregnancy. Obstet Gynecol 1980;56:186–92.
27. Gemer O, Segal S, Kopmar A, et al. The current clinical presentation of complete molar pregnancy. Arch Gynecol Obstet 2000;264:33–4.
28. Jauniaux E. Partial moles: from postnatal to prenatal diagnosis. Placenta 1999;20:379–88.
29. Buli_c M, Bistricki J, Podobnik M, et al. Evacuation of a hydatidiform mole with ultrasonic guidance.Jugosl Ginekol Opstet 1983;23:85–8.
30. Maymon R, Schneider D, Shulman A, et al. Serial color Doppler flow of uterine vasculature combined with serum beta-hCG measurements for improved monitoring of patients with gestational trophoblastic disease. A preliminary report. Gynecol Obstet Invest 1996;42:201–5.
molar pregnancy. BJOG 2003;110:22–6.
31. Gottesfeld KR, Taylor ES, Thompson HE, et al.
Diagnosis of hydatidiform mole by ultrasound. Obstet Gynecol 1967;30:163–71.
32. Kohorn EI, Blackwell RJ. The diagnosis of hydatidiform mole by ultrasonic B-scanning. J Obstet Gynaecol Br Commonw 1968;75(1):014–8.
33. Nikolic B, Lukic R. Choriocarcinoma – postdisease ultrasonographic
findings. Int J Gynecol Cancer 2004; 14: 677–679.
Copyright (c) 2021 IJRDO - Journal of Biological Science (ISSN: 2455-7676)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Author(s) and co-author(s) jointly and severally represent and warrant that the Article is original with the author(s) and does not infringe any copyright or violate any other right of any third parties, and that the Article has not been published elsewhere. Author(s) agree to the terms that the IJRDO Journal will have the full right to remove the published article on any misconduct found in the published article.
