Analysis Of Clinical Characteristics And Influencing Factors Of Pregnancy Outcomes Of A Twin Pregnancy Consisting Of Complete Hydatidiform Mole And Co-existing Fetus:A Case Report

Purpose To analyze the clinical characteristics of a twin pregnancy consisting of complete hydatidiform mole and co-existing fetus（CHMCF）,and explore the related factors affecting the pregnancy outcome of CHMCF patients,so as to provide clinical basis for evaluating the prognosis of mother and fetus.Methods The clinical data of 186 patients with CHMCF retrieved from CNKI,Wanfang,Vip and Pubmed databases from January 2000 to July 2022 and 1 patient with CHMCF admitted to Shenzhen Second People’s Hospital of Guangdong Province in May 2020 were analyzed retrospectively;187 patients with CHMCF were divided into two groups according to whether the fetus was born alive（60 cases）and fetal adverse outcome group（127 cases）.The clinical characteristics of the two groups were compared.The influencing factors of fetal adverse outcome were analyzed by multivariate logistic regression,and the receiver operating characteristic（ROC）was drawn to evaluate the predictive efficacy of each influencing factor and the combined predictive factor;The clinical data of 187 patients with CHMCF were divided into p GTN group（64 cases）and non-p GTN group（123 cases）according to whether they had post-gestational trophoblastic neoplasia（p GTN）after termination of pregnancy.The clinical characteristics of the two groups were compared,and the factors related to the occurrence of p GTN after termination of pregnancy were analyzed by multivariate logistic regression.Results（1）The average age of 187 patients was 29.62±5.49 years;57 patients（30.48%）were pregnant after assisted reproductive technology treatment,of which 22 patients were treated with ovulation promoting drugs,and 35 patients were pregnant after in vitro fertilization and embryo transfer;The average gestational age of the patients was15.25±2.90 weeks,55 patients（29.41%）were diagnosed at<14 weeks,129 patients（68.98%）were diagnosed at 14～27⁺⁶weeks,and only 3 patients were diagnosed at≥28 weeks;107 patients（57.22%）had vaginal bleeding,45 patients（24.06%）complicated with hypertensive disorder complicating pregnancy,28 patients（14.97%）complicated with hyperemesis gravidarum,32 patients（17.11%）complicated with hyperthyroidism,and 20 patients（10.6%）complicated with luteinized ovarian cyst;All patients showed an abnormal increase in serum human chorionic gonadotropin（h CG）after diagnosis,with a median value of 352878 m IU/ml and a range of（10000～10000000）m IU/ml;60 patients（32.09%）had live births,and the other 127patients（67.91%）had no live births;PGTN occurred in 64 patients（34.22%）after termination of pregnancy.（2）The results of univariate analysis showed that the diagnosis of gestational age,the peak value of serum h CG,vaginal bleeding and hypertension during pregnancy were all related to the adverse fetal outcome of CHMCF patients（P<0.05）.The results of multivariate logistic regression analysis showed that vaginal bleeding（OR=3.514,95%CI 1.462～8.445）,hypertensive disorders of pregnancy（OR=3.500,95%CI1.212～10.109）,the highist value of serum h CG≥443 197 m IU/ml（OR=4.490,95%CI 1.816～11.102）was the influencing factors of fetal adverse outcome（P<0.05）.The ROC curve showed that vaginal bleeding,hypertensive disorders of pregnancy,the highist value of serum h CG≥443 197 m IU/ml and combined predictive factors had certain predictive value for adverse fetal outcomes,of which the combined predictive factors had the highest predictive value,with the area under the curve of 0.763（95%CI0.675～0.850）.（3）The results of univariate analysis showed that the weeks of termination of pregnancy,the highist value of serum h CG,hyperthyroidism,and fetal live birth were all related to the occurrence of p GTN after termination of pregnancy in CHMCF patients（P<0.05）.The results of multivariate logistic regression analysis showed that the weeks of termination of pregnancy（OR=0.948,95%CI 0.841～3.139）,the highist value of serum h CG（OR=0.599,95%CI 0.206～1.737）,hyperthyroidism（OR=1.459,95%CI 0.380～5.596）and fetal live birth（OR=0.380,95%CI 0.046～3.139）was not the influencing factors of p GTN after termination of pregnancy in CHMCF patients（P>0.05）。Conclusions CHMCF patients have the risk of complications during pregnancy and p GTN after termination of pregnancy.When there are no obvious maternal and fetal complications,they can choose to continue pregnancy under close monitoring.Prenatal vaginal bleeding,gestational hypertension,and abnormal elevation of serum h CG peak are risk factors for fetal adverse outcomes in CHMCF patients.Combined predictive factors have certain predictive value for fetal adverse outcomes in CHMCF patients...