Razi Journal of Medical Sciences

fa بررسی مقایسه‌ای تظاهرات بالینی حانلگی مولار کامل در مقابل حاملگی مولار ناکامل در سال‌های 1385-1397 Comparison of clinical presentation of complete molar pregnancy and partial molar pregnancy in Imam Reza teaching hospital 2006-2018 زنان و زایمان Gynecology پژوهشي Research زمینه و هدف: حاملگی مولر به عنوان یکی از بیماریهای حاملگی  بیماری ترفوبلاستیک بارداری (GTD) است که از جفت پدیدار می‌شود و عنوان یکی از گروه‌های بیماری طبقه‌بندی می‌شود. مول‌های هیداتی فرم، 1 در هر 1500 تا 2000 بارداری در ایالات متحده تشخیص داده می‌شوند. به نظر می‌رسد تغییرات زیادی در توسعه مول وجود دارد و فراوانی آن در شرق آسیا از کشورهای غربی بیشتر است. مول به دو نوع کامل و ناقص تقسیم می‌شود. هدف ما مقایسه کلینیکی حاملگی کامل مولر و بارداری ناقص مولر در بیمارستان آموزشی امام رضا (ع) در سال‌های 1385-1397 است. روش کار: در طی یک دوره ده ساله 289 بیمار که از نظر بالینی بارداری مولار داشتند به بیمارستان آموزشی امام رضا (ع) کرمانشاه مراجعه کرده بودند. نتایج این مطالعه بر اساس سونوگرافی، معاینه جسمی، گزارش پاتولوژی و آزمایش انجام شده از بیمار است. تجزیه و تحلیل با استفاده از نرم‌افزار SPSS نسخه 16 انجام شد. آزمونT ، مجذور کای، آزمون ویلکاکسون.  ارزش P کمتر از 05/0 از سطح معنی‌دار آماری معنی‌دار در نظر گرفته شد. یافته‌ها: در این مطالعه، بیشتر مادران باردار مولر در گروه سنی 25-45 سال قرار داشتند، زیرا در این سن قدرت باروری زیاد است و پس از آن محدوده سنی 15-24 در رتبه دوم قرار دارد. از طرف دیگر، مول جزئی با بالاترین فراوانی در سن 15-24 سال بود. در مطالعه حاضر، 114 زن باردار (1/48 درصد)Nullipar  بودند و 123 نفر (9/51 درصد)  Multipar بودند. اندازه رحم در حاملگی کامل مول بزرگ‌تر از مول جزئی بود. در این مطالعه فقط اندازه رحم از نظر آماری ارتباط معنی‌داری با حاملگی مولر داشت (017/0P = ) و بین سایر متغیرها در مطالعه ما و بارداری مولر رابطه معنی‌داری مشاهده نشد. نتیجه‌گیری: با توجه به ارتباط معنی‌دار اندازه رحم و اهمیت آن، باید در مطالعات بعدی به‌عنوان یک شاخص مهم مورد توجه قرار گیرد. Background & Aims: Molar pregnancy is one of the gestational diseases of pregnancy trophoblastic disease (GTD) which is a free phenomenon and is classified as one of the disease groups. Gestational trophoblastic disease (GTD) is a term that includes a group of tumors that are characterized by abnormal proliferation of human placental gonadotropin trophoblast (hCG); Guide to Encouraging GTD, Administration, and Related Care It is essential to measure these peptide hormones in serum. Hydatid mole is diagnosed in 1 in 1,500 to 2,000 pregnancies in the United States. There seems to be a lot of change in mole development, and it is more prevalent in East Asia than in Western countries. Mole is divided into two types, complete and incomplete. A complete hydatidiform mole has abnormal chorionic villi that can be seen with the naked eye as a mass with clear vesicles. The size of the vesicles varies and often hangs in clusters of thin bases. Conversely, in incomplete mole pregnancies, hydatidiform changes are focal and less severe; Incomplete moles also contain some embryonic tissues. Although both types of moles fill the uterine cavity, their occurrence in the form of tubular pregnancy or other forms of ectopic pregnancy is rare. Over the past few decades, the clinical manifestations of mole pregnancies have changed significantly due to the earlier application of women for prenatal care as well as the widespread prevalence of ultrasound. As a result, most mole pregnancies are diagnosed more than they are enlarged and cause complications. Due to rapid diagnosis, timely evacuation, and careful post-evacuation monitoring for GTN, maternal mortality rate due to molar pregnancy has become rare. The purpose of preoperative evaluations is to identify known known complications such as preeclampsia, hyperthyroidism, anemia, decreased electrolytes due to severe vomiting, and metastatic disease. After molar pregnancy, monitoring is very important to identify subsequent neoplasms. Therefore, moles should be histologically differentiated from other cases of pregnancy failure that cause hydropic analysis of the placenta; These can mimic the hair changes that occur in a mole pregnancy. Classic molar changes may not be seen before the tenth week of pregnancy; Because the villi have not yet grown and the molar stroma may not have been edematous and without blood vessels, other techniques are used to differentiate. One technique uses a difference in ploidy to differentiate between defective (triploid) moles and diploid products. Excluding rare cases, molar pregnancies can be considered the result of chromosomally abnormal fertilizations. The chromosomal composition in a complete mole is generally diploid. Chromosome composition is usually XX46, and both chromosomes are of paternal origin, a phenomenon called androgenesis. Complete moles and non-molar pregnancies with placental hydropic analysis are both diploid. The aim of clinical comparison is complete molar pregnancy and incomplete molar pregnancy in Imam Reza (AS) Teaching Hospital in Kermanshah. Methods: During a twelve-year period, 237 patients who were clinically pregnant were referred to Imam Reza (AS) Teaching Hospital in Kermanshah in 2018-2006. Although sonography is the main method of diagnosing trophoblastic disease, all cases They are not approved at first. The term "snowstorm" is commonly used to describe this view. Ultrasound image of a complete mole contains an echogenic uterine mass that has a large number of echo-free cystic spaces, but no embryo or amniotic sac is seen. It is an embryo or at least an embryonic tissue. However, in early pregnancy, ultrasound will show the above clear appearance in only half of the cases of hydatidiform mole. The results of this study are based on ultrasound, physical examination, pathology report and examination of the patient. Analysis was performed using SPSS software version 16, T test, Chi-square, Wilcoxon test. Results: In this study, the strongest risk factors are age and history of hydatidiform mole in previous pregnancies. Women on both sides of the reproductive age range are at greater risk. Most of molar's pregnant mothers were in the age group of 25-45 years, because at this age the fertility is high, followed by the age range of 24-24. On the other hand, partial moles had the highest frequency at the age of 15-24 years. In the present study, 114 pregnant women (48.1%) were nulliparous and 123 (51.9%) were multiparous. The size of the uterus in full pregnancy was larger than the partial mole (flesh mass). The most common clinical sign was vaginal bleeding. Uterine size in full molar pregnancy was larger than incomplete molar, which was statistically significant. Hyperemesis was higher in complete mole than incomplete mole, although this difference was not significant, but its P. Value level was close to significant and was calculated to be around 0.06. The frequency of complete moles was higher than incomplete moles. The highest frequency of blood group was related to O positive and the lowest frequency of blood group was related to AB negative. Most cases of complete molar pregnancy were 11-17 weeks in gestational age and less than 10 weeks in incomplete moles. Most pregnant mothers had multiple molar pregnancies. The majority of patients with the diagnosis of molar pregnancy were urban. In this study, only the size of the uterus was statistically significantly associated with molar pregnancy (P = 0.017) and no significant relationship was observed between other variables in our study and molar pregnancy. Conclusion: The clinical manifestations of complete molar pregnancy were similar to incomplete molar and were not statistically significant. And in two study groups where complete and incomplete moles were compared. The results showed that the majority of women who had molar pregnancies lived in the city and there was no statistically significant difference. Considering the significant relationship between uterine size and its importance, it should be considered as an important indicator in future studies and is an important and helpful indicator in diagnosing complete mole pregnancy from incomplete mole. حاملگی مولر , ارائه بالینی , مولر کامل. بیماری حاملگی Trophoblastic Molar pregnancy, Clinical presentation, Complete mole, Trophoblastic gestational disease 21 28 http://rjms.iums.ac.ir/browse.php?a_code=A-10-5045-1&slc_lang=fa&sid=1 Anisodowleh Nankali انیس الوله نانکلی Anis_nankali@yahoo.com 3900319475328460060127 3900319475328460060127 No دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران saba zakeri صبا ذاکری sabazakeri63@gmail.com 3900319475328460060128 3900319475328460060128 No دانشگاه علوم پزشکی کرمانشاه، بیمارستان امام رضا کرمانشاه، کرمانشاه، ایران Daryoush Pourmand داریوش پورمند Pourmand_D@yahoo.com 3900319475328460060130 3900319475328460060130 No دانشگاه علوم پزشکی کرمانشاه، کرانشاه، ایران karim zamanfar کریم زمان فر dav.zamani@yahoo.com 3900319475328460060129 3900319475328460060129 Yes دانشگاه علوم پزشکی کرمانشاه، کرمانشاه، ایران