D. Raudrant

Twin pregnancy with complete hydatidiform mole and coexistent fetus Obstetrical and oncological outcomes in a series of 14 cases

OBJECTIVEnTwin pregnancy with complete hydatidiform mole and coexistent fetus (CHM&CF) is a rare situation and a challenge for diagnosis. Results related to fetal outcome and maternal risk of subsequent gestational trophoblastic neoplasia (GTN) are controversial. We here display a series from the French Trophoblastic Disease Reference Center, which is to date the third in number of cases registered by the same center.nnnSTUDY DESIGNnBy retrospective method based on patients from the French Trophoblastic Disease Reference Center data base between November 1999 and December 2006, 17 assumed cases were reviewed. In 14 cases the diagnosis of CHM&CF was ascertained. All files were reviewed to confirm diagnosis. Methods of initial diagnosis, outcome of pregnancy and evolution to GTN were studied.nnnRESULTSnIn 10 cases (71%) diagnosis was made by ultrasonography. Differential diagnoses were partial hydatidiform mole and mesenchymal dysplasia. Three patients in 14 (21%) delivered a healthy child. In only one case, delivery occurred after 37 weeks of gestation. Seven patients (50%) had a diagnosis of GTN. No patient had fatal evolution. Clinical events, such as vaginal bleeding, pre-eclampsia or hyperthyroidism, had no effect on the evolution to GTN. Continuation of the pregnancy did not increase the risk of GTN.nnnCONCLUSIONnIn case of prenatal diagnosis of CHM&CF, and even if delivery of a healthy child is possible, patients should be aware of a possibly higher risk of GTN than in CHM.

Sexuality after sigmoid vaginoplasty in patients with Mayer-Rokitansky-Küster-Hauser syndrome

OBJECTIVEnTo investigate the functional and sexual outcome of sigmoid vaginoplasty in patients with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome.nnnDESIGNnProspective study.nnnSETTINGnUniversity hospital.nnnPATIENT(S)nFifty-nine consecutive patients with MRKH syndrome.nnnINTERVENTION(S)nForty-eight patients underwent sigmoid vaginoplasty, and 11 were treated using the Frank method of dilatation.nnnMAIN OUTCOME MEASURE(S)nFunctional results and sexuality were evaluated with the use of two standardized questionnaires: the Female Sexual Function Index (FSFI) and the revised Female Sexual Distress Scale (FSDS-R). Questions were added to analyze depression, body image perception, and desire of motherhood.nnnRESULT(S)nOut of the 68% of patients who answered the questionnaire, 73% had regular sexual intercourse. The mean total FSFI score was 28 ± 3.1 in the operated group and 30 ± 5.3 in the group treated with the Frank method. Their mean FSDS-R scores were 21 ± 12.1 and 18 ± 13.8, respectively.nnnCONCLUSION(S)nSigmoid vaginoplasty is an effective technique providing a nearly normal sexual function to patients with vaginal aplasia. Despite this, psychologic distress related to sexuality persists in most patients, demonstrating the need for a multidisciplinary support.

Risk of gestational trophoblastic neoplasia after hCG normalisation according to hydatidiform mole type.

OBJECTIVEnThe risk of gestational trophoblastic neoplasia (GTN) after a hydatidiform mole (HM) is well known. However, the risk of GTN after normalisation of hCG in HM is poorly reported. The aim of this study was to evaluate the risk of GTN after normalisation of hCG according to HM types.nnnMETHODSnThis prospective cohort study carried out between 2000 and 2010 used the database of the French Trophoblastic Disease Centre (FTDC). A total of 2008 registered patients with ascertained types of HM were analysed. Cases of GTN occurring after normalisation of hCG were analysed.nnnRESULTSnA GTN developed in 239 out of 1980 HMs (12.1%) and 6 out of these 239 post-molar GTN (2.5%) were diagnosed after normalisation of hCG. The risk of GTN after normalisation of hCG was 0.34% (6/1747) following a HM, 0% (0/593) after a partial HM (PHM), 0.36% (4/1122) after a complete HM (CHM), and 9.5% (2/21) after a multiple pregnancy with HM.nnnCONCLUSIONSnThe risk of post-molar GTN justifies hCG monitoring in all women with HM. However, after normalisation of hCG, monitoring of PHM can be stopped safely while it should be maintained for CHM and more importantly for multiple pregnancies with HM.

Paralysie sciatique transitoire après embolisation de l’artère utérine

Early postpartum bleeding remains in France the leading cause of maternal mortality in perinatal period. In association with obstetrical and medical measures to control bleeding, uterine arteries embolization constitutes an efficient non-surgical measure whose potential side effects must be kept in mind. We report the case of a patient that presented a popliteal sciatic paralysis in the hours following the procedure. Through this case, we will review the different types of embolization complications.

Cas cliniqueParalysie sciatique transitoire après embolisation de l’artère utérineSciatic paralysis following uterine artery embolization

Early postpartum bleeding remains in France the leading cause of maternal mortality in perinatal period. In association with obstetrical and medical measures to control bleeding, uterine arteries embolization constitutes an efficient non-surgical measure whose potential side effects must be kept in mind. We report the case of a patient that presented a popliteal sciatic paralysis in the hours following the procedure. Through this case, we will review the different types of embolization complications.

Môles hydatiformes et tumeurs trophoblastiques gestationnelles

Partial and complete hydatidiform moles can secondarily turn to gestational trophoblastic neoplasia (GTN). Diagnosis of GTN is made when hCG does not return to normal value after a molar pregnancy or when histology findings show a choriocarcinoma. A check-up for metastasis allows calculating the FIGO score that differentiates low risk patients treated with methotrexate from high risk patients treated with polychemotherapy. The French trophoblastic disease reference centre has been implemented as an entity within a network organised between Lyon, Tours, Paris and Marseille; this network aims to register patients and optimize the treatment of GTN patients in France.RésuméLes môles hydatiformes complètes et partielles peuvent se compliquer à distance par une tumeur trophoblastique gestationnelle. Le diagnostic de tumeur repose sur l’évolution anormale des hCG dans les suites d’une môle ou plus rarement sur l’histologie de choriocarcinome. Le bilan d’extension des tumeurs permet de calculer le score FIGO qui définit les tumeurs à bas risque à traiter par méthotrexate et les tumeurs à haut risque à traiter par polychimiothérapie. Le centre français de référence des maladies trophoblastiques fonctionne en réseau entre Lyon, Tours, Paris et Marseille avec pour buts d’enregistrer les patientes et d’optimiser leur prise en charge en France.