The Clinical Analysis Of Hydatidiform Mole And Comparative Analysis Of Hydatidiform Mole Malignant Transformation Rate

Objective:To investigate the clinical features of hydatidiform mole and the current trend in clinical features of hydatidiform mole; to compare the hydatidiform mole malignant transformation rate of unigravida with patients who have pregnancy3times or over; to guide the early diagnosis, treatment and follow-up of hydatidiform mole.Methods:One hundred and eighty cases of hydatidiform mole treated in Qilu Hospital of Shandong University Medical College during1996-2011were studied retrospectively.A do descriptive statistics of total180cases about the clinical data, clinical manifestations, the results of laboratory examinations, treatment and malignant transformation.B the patients were divided into2groups according to the year of first hospital admission. The first group was from January1996to December2003, the second group for the January2004to July2011. x2test or non-parametric tests was performed analyzing their general gata.clinical manifestations, treatment, malignant transformation. C compare the hydatidiform mole malignant transformation rate of unigravida with patients who have pregnancy3times or over. We considered P<0.05to be significant.Results:A. The median age was28years (ranges from19to55years). The median gestational age was72.5days (ranges from41to245days). Vaginal bleeding is the most common presenting symptom, occurring in146of180cases (81.1%). Abdominal pain occurred in43of180cases (23.8%). Sixty-four of180cases (35.6% presented with excessive uterine size. Pregnancy induced hypertension symdrome, hyperemesis, hemoptysis and thecaluteincysts occurred in7(3.9%),13(7.2%),2(1.1%) and29of113cases (16.1%) respectively. Incidence of postmolar trophoblastic neoplasia was20%(36of180).B. The first group was from January1996to December2003, containing60cases. The second group was from the January2004to July2011containing120cases. In the first group, the median gestational age at diagnosis was80.5days; while in the second group, it is69days,and there were significant differences(P<0.05). The median age of group1was27years,while the median age of group2was28years, and there was no significant difference(P>0.05). Vaginal bleeding ocurred in54cases of60patients in group1(90%),compared with92of120cases(76.7%) of group2(P<0.05). Abdominal pain of varying degrees ocurred in23of60cases (38.3%),compared with20of120cases (16.7%) of group2(P<0.05). Excessive uterine size presented in21of60cases (35%) of group1and in43of120cases (35.8%) of group2(P>0.05). Ovarian luteinized cysts were present in25%(15of60cases) of the patients in group1and in11.6%(15of120cases) of group2and statistical significance could be obtained (P<0.05). Hyperemesis was significantly different in the two groups (group1:13.3%; group2:4.2%; PO.05). In group1we found5cases (8.3%) of pregnancy-induced hypertension. In group2we found only2(1.7%) patients with such complication and this discrepancy was statistically significant (P<0.05). Incidence of postmolar trophoblastic neoplasia was16.7%(10of60cases) in group1, compared with21.7%(26of120cases) in group2(P>0.05). Compared group2to group1, the incidence of vaginal bleeding abdominal pain, ovarian luteinized cysts, hyperemesis and pregnancy induced hypertension symdrome were statistically lower (P<0.05), while the incidence of postmolar gestation trophoblastic neoplasia(GTN) was increased moderately without statistical significance (P>0.05). C. The hydatidiform mole malignant transformation rate of unigravida was11.7%(7of60cases), compared with25.7%(18of70cases) in patients who have pregnancy3times or over (P<0.05), and there was statistically significant difference (P>0.05). Conclusions:1.The most common clinical manifestations of hydatidiform mole is vaginal bleeding after menopause. The treatment of first choice is suction curettage.2..In recent years, due to pelvic ultrasonography and serum HCG testing widely used in obstetrics, the patients with hydatidiform mole have been diagnosed earlier in gestation. The incidence of vaginal bleeding, abdominal pain, ovarian luteinized cysts, hyperemesis and pregnancy induced hypertension symdrome statistically reduced. Hydatidiform mole malignant transformation rate increased slightly, but not statistically significant.3.Hydatidiform mole malignant transformation rate of unigravida was significantly lower than that of patients who have pregnancy3times or over. So maybe it is feasible to shorten the contraceptive time of unigravida of low-risk who do not receive prophylactic chemotherapy.