GynecologyGynecologyГинекология2079-56962079-5831Consilium Medicum3346710.26442/20795696.2019.2.190347ArticlesСтатьиResearch ArticleHydatidiform mole: a clinical case of pregnancyПузырный занос: клинический случай ведения беременностиDobrokhotovaIuliia EДоброхотоваЮлия Эдуардовна

D. Sci. (Med.), Full. Prof.

д-р мед. наук, проф., зав. каф. акушерства и гинекологии лечебного фак-та

ArakelovSergey EАракеловСергей Эрнестович

D. Sci. (Med.)

д-р мед. наук, глав. врач

gkb40@zdrav.mos.ruDanielyanSonia ZДанелянСоня Жоровна

Cand. Sci. (Med.)

канд. мед. наук, зам. глав. врача по акушерству и гинекологии

gkb40@zdrav.mos.ruBorovkovaEkaterina IБоровковаЕкатерина Игоревна

D. Sci. (Med.)

д-р мед. наук, проф. каф. акушерства и гинекологии лечебного фак-та

katyanikitina@mail.ruZalesskaiaSofia AЗалесскаяСофья Алексеевна

Аssistant

ассистент каф. акушерства и гинекологии лечебного фак-та

MedzhidovaMargenat KМеджидоваМаржанат Капуровна

Cand. Sci. (Med.)

канд. мед. наук, зав. обсервационным отд-нием родильного дома

NagaytsevaElena AНагайцеваЕлена Анатольевна

Cand. Sci. (Med.)

канд. мед. наук, зав. отд-нием ультразвуковой диагностики родильного дома

Pirogov Russian National Research Medical UniversityФГБОУ ВО «РНИМУ им. Н.И. Пирогова»City Clinical Hospital №40ГБУЗ ГКБ №4015042019212VOL 21, NO2 (2019)ТОМ 21, №2 (2019)283316042020Copyright ©; 2019, Consilium MedicumCopyright ©; 2019, ООО "Консилиум Медикум"2019Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://gynecology.orscience.ru/2079-5831/article/view/33467

Hydatidiform mole (HM) is a disease of trophoblast tissue with saved proliferative potential and it develops after aberrant fertilization. Complete HM is characterized by a rapid increase in a size of the uterus, a significant increase in human b-chorionic gonadotropin (hCG), bleeding, symptoms of hyperthyroidism, severe vomiting of pregnant, and early preeclampsia. Thecalutein cysts are formed in the ovaries as a result of exposure to high titers of hCG and prolactin. Multiple pregnancy may be complicated by the development of complete and partial HM in one of the fetuses in one case for 20 000-100 000 pregnancies. The article presents a clinical case of pregnancy care of a 32-year-old woman with dichorial biamniotic twins and a complete HM of one fetus. Pregnancy occurred spontaneously, proceeded with threatening miscarriage up to 12 weeks, threatened preterm labor, pre-eclampsia from 24 weeks. The patient underwent induction of labor at 28 weeks due to severe pre-eclampsia, a live premature girl with a weight of 1030 g weight, height of 33 cm tall and Apgar score of 6/7 points was born. On the 40th day after birth, b-hCG level was negative.

Пузырный занос (ПЗ) представляет собой заболевание из ткани трофобласта с сохраненным пролиферативным потенциалом и развивается после аберрантного оплодотворения. Для полного ПЗ характерны быстрое увеличение размеров матки, значительное повышение уровня b-хорионического гонадотропина человека (ХГЧ), кровотечение, симптомы гипертиреоза, тяжелое течение рвоты беременных и раннее развитие преэклампсии. Текалютеиновые кисты формируются в яичниках в результате воздействия высоких титров ХГЧ и пролактина. Многоплодная беременность может осложняться развитием полного и частичного ПЗ у одного из плодов в одном случае на 20 000-100 000 беременностей. В статье представлен клинический случай сопровождения беременной 32 лет с бихориальной биамниотической двойней и полным ПЗ одного плода. Беременность наступила спонтанно, протекала с угрозой прерывания до 12 нед, угрожающими преждевременными родами, преэклампсией с 24 нед. Пациентка была родоразрешена в 28 нед в связи с тяжелой преэклампсией, рождена живая недоношенная девочка массой 1030 г, ростом 33 см с оценкой по шкале Апгар 6/7 баллов. На 40-е сутки после родов уровень b-ХГЧ отрицательный.

hydatidiform moletrophoblastic diseasemultiple pregnancychorionic gonadotropinpreeclampsiathecalutein cystsпузырный занострофобластическая болезньмногоплодная беременностьхорионический гонадотропинпреэклампсиятекалютеиновые кистыBerkowitz R.S, Goldstein D.P. Current advances in the management of gestational trophoblastic disease. Gynecol Oncol 2013; 128: 3.Altieri A, Franceschi S, Ferlay J et al. Epidemiology and aetiology of gestational trophoblastic diseases. Lancet Oncol 2003; 4: 670.Azuma C, Saji F, Tokugawa Y et al. Application of gene amplification by polymerase chain reaction to genetic analysis of molar mitochondrial DNA: the detection of anuclear empty ovum as the cause of complete mole. Gynecol Oncol 1991; 40: 29.Szulman A.E, Surti U. The syndromes of hydatidiform mole. I. Cytogenetic and morphologic correlations. Am J Obstet Gynecol 1978; 131: 665.Melamed A, Gockley A.A, Joseph N.T et al. Effect of race/ethnicity on risk of complete and partial molar pregnancy after adjustment for age. Gynecol Oncol 2016; 143: 73.Vargas R, Barroilhet L.M, Esselen K et al. Subsequent pregnancy outcomes after complete and partial molar pregnancy, recurrent molar pregnancy, and gestational trophoblastic neoplasia: an update from the New England Trophoblastic Disease Center. J Reprod Med 2014; 59: 188.Hershman J.M. Physiological and pathological aspects of the effect of human chorionic gonadotropin on the thyroid. Best Pract Res Clin Endocrinol Metab 2004; 18: 249.Braga A, Moraes V, Maestá I et al. Changing Trends in the Clinical Presentation and Management of Complete Hydatidiform Mole Among Brazilian Women. Int J Gynecol Cancer 2016; 26: 984.Committee on Practice Bulletins-Gynecology, American College of Obstetricians and Gynecologists. ACOG Practice Bulletin #53. Diagnosis and treatment of gestational trophoblastic disease. Obstet Gynecol 2004; 103: 1365.Benson C.B, Genest D.R, Bernstein M.R et al. Sonographic appearance of first trimester complete hydatidiform moles. Ultrasound Obstet Gynecol 2000; 16: 188.Fowler D.J, Lindsay I, Seckl M.J, Sebire N.J. Routine pre-evacuation ultrasound diagnosis of hydatidiform mole: experience of more than 1000 cases from a regional referral center. Ultrasound Obstet Gynecol 2006; 27: 56.Seckin K.D, Baser E, Yeral I et al. The impact of ultrasonographic lesion size and initial human chorionic gonadotropin values on treatment success in cases with complete hydatidiform mole. Eur Rev Med Pharmacol Sci 2013; 17: 3381.Niemann I, Hansen E.S, Sunde L. The risk of persistent trophoblastic disease after hydatidiform mole classified by morphology and ploidy. Gynecol Oncol 2007; 104: 411.Shazly S.A, Ali M.K, Abdel Badee A.Y et al. Twin pregnancy with complete hydatidiform mole and coexisting fetus following ovulation induction with a non-prescribed clomiphene citrate regimen: a case report. J Med Case Rep 2012; 6: 95.Hancock B.W, Nazir K, Everard J.E. Persistent gestational trophoblastic neoplasia after partial hydatidiform mole incidence and outcome. J Reprod Med 2006; 51: 764.Massardier J, Golfier F, Journet D et al. Twin pregnancy with complete hydatidiform mole and coexistent fetus: obstetrical and oncological outcomes in a series of 14 cases. Eur J Obstet Gynecol Reprod Biol 2009; 143: 84.Niemann L, Fisher R, Sebire N.J. et al. Update on UK outcomes for women with twin pregnancies comprising a complete hydatidiform mole and normal co-twin. XVII World Congress on Gestational Trophoblastic Disease. 2013; p. 57 (abstract).Steller M.A, Genest D.R, Bernstein M.R et al. Clinical features of multiple conception with partial or complete molar pregnancy and coexisting fetuses. J Reprod Med 1994; 39: 147.Lin L.H, Maestá I, Braga A et al. Multiple pregnancies with complete mole and coexisting normal fetus in North and South America: A retrospective multicenter cohort and literature review. Gynecol Oncol 2017; 145: 88.Matsui H, Sekiya S, Hando T et al. Hydatidiform mole coexistent with a twin live fetus: a national collaborative study in Japan. Hum Reprod 2000; 15: 608.Tidy J.A, Gillespie A.M, Bright N et al. Gestational trophoblastic disease: a study of mode of evacuation and subsequent need for treatment with chemotherapy. Gynecol Oncol 2000; 78: 309.Tse K.Y, Chan K.K, Tam K.F, Ngan H.Y. 20-year experience of managing profuse bleeding in gestational trophoblastic disease. J Reprod Med 2007; 52: 397.Elias K.M, Shoni M, Bernstein M et al. Complete hydatidiform mole in women aged 40 to 49 years. J Reprod Med 2012; 57: 254.Elias K.M, Goldstein D.P, Berkowitz R.S. Complete hydatidiform mole in women older than age 50. J Reprod Med 2010; 55: 208.Fu J, Fang F, Xie L et al. Prophylactic chemotherapy for hydatidiform mole to prevent gestational trophoblastic neoplasia. Cochrane Database Syst Rev 2012; 10: CD007289.Limpongsanurak S. Prophylactic actinomycin D for high-risk complete hydatidiform mole. J Reprod Med 2001; 46: 110.FIGO Committee on Gynecologic Oncology. Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia. Int J Gynaecol Obstet 2009; 105: 3.Adewole I.F, Oladokun A, Fawole A.O et al. Fertility regulatory methods and development of complications after evacuation of complete hydatidiform mole. J Obstet Gynaecol 2000; 20: 68.Feltmate C.M, Growdon W.B, Wolfberg A.J et al. Clinical characteristics of persistent gestational trophoblastic neoplasia after partial hydatidiform molar pregnancy. J Reprod Med 2006; 51: 902.Vargas R, Barroilhet L.M, Esselen K et al. Subsequent pregnancy outcomes after complete and partial molar pregnancy, recurrent molar pregnancy, and gestational trophoblastic neoplasia: an update from the New England Trophoblastic Disease Center. J Reprod Med 2014; 59: 188.Sebire N.J, Fisher R.A, Foskett M et al. Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy. BJOG 2003; 110: 22.