gemeprost and Uterine-Neoplasms

A twin pregnancy consisting of complete hydatidiform mole with coexisting fetus is an extremely rare condition. Recent advances in obstetric ultrasonography and cytogenetic analysis have made the prenatal diagnosis of this rare pregnancy possible. Recent literature advocating DNA polymorphism analysis being required for the accurate diagnosis of complete hydatidiform mole with coexisting fetus is discussed. We present a case of complete hydatidiform mole with coexisting fetus terminated at 16 weeks' gestation. After successful termination of the pregnancy with intravaginal gemeprost, androgenesis of the molar placenta was proven by karyotyping analysis only, without DNA polymorphism analysis, because the short arm of chromosome 21 of the paternal allele had the normal variant satellite. To our knowledge, this is the first case report of complete hydatidiform mole with coexisting fetus diagnosed by variation of the acrocentric short arms, followed by termination with intravaginal gemeprost. We describe the clinical course of our case and review some literature concerning complete hydatidiform mole with coexisting fetus.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Alprostadil; Chromosome Aberrations; Chromosomes, Human, Pair 21; Female; Fetus; Genetic Variation; Humans; Hydatidiform Mole; Karyotyping; Pregnancy; Pregnancy Trimester, First; Ultrasonography, Prenatal; Uterine Neoplasms

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Alprostadil; Female; Humans; Hydatidiform Mole; Mifepristone; Pregnancy; Uterine Neoplasms

A 19-year-old virgin presented with severe menorrhagia and a haemoglobin level of 76 g/L as a problem of management. A 5 cm diameter submucous fibroid was identified at hysteroscopy and biopsied but was unable to be removed. The luteinising hormone releasing hormone agonist, buserelin, was used in an attempt to produce symptomatic relief. One week after commencing buserelin therapy, severe menorrhagia occurred and the patient was admitted to hospital with a haemoglobin concentration of 24 g/L. Buserelin treatment was continued and no further menstruation occurred over the following year. As the patient was now well, hysteroscopic submucous fibroid resection was contemplated. Due to cervical rigidity in this teenager, a 1 mg gemeprost pessary was inserted into the posterior vaginal fornix three hours before surgery. This allowed an operative hysteroscope to be inserted into the uterus and a fibroid resection to be performed. Menstrual blood loss has been normal for six months after hysteroscopy. A combined medical and surgical approach may avoid hysterectomy in such problem patients.

Topics: Adult; Alprostadil; Buserelin; Cervix Uteri; Dilatation; Female; Humans; Hysteroscopy; Leiomyoma; Menorrhagia; Pessaries; Uterine Neoplasms

Forty-eight patients affected with missed abortion, intrauterine fetal death and hydatiform mole were treated with vaginal suppositories containing 1 mg of 16,16-dimethyl-trans-delta 2-PGE1 methyl ester (ONO-802). The patients were divided into two treatment groups. The first, Group A, was given one vaginal suppository every 3 h to a maximum of five suppositories. The product of conception was expelled in 95.8% of patients. In Group B the maximum number of suppositories was reduced to three. The product of conception was expelled in 100% of cases and the average duration of treatment was similar to that for the first group. Although side-effects were mild in both groups, they were reduced in the patients of Group B.

Topics: Abortifacient Agents; Abortifacient Agents, Nonsteroidal; Abortion, Missed; Administration, Intravaginal; Adult; Alprostadil; Dose-Response Relationship, Drug; Drug Evaluation; Female; Fetal Death; Humans; Hydatidiform Mole; Middle Aged; Pregnancy; Prostaglandins E, Synthetic; Suppositories; Time Factors; Uterine Neoplasms