Risk factors for gestational trophoblastic disease: a separate analysis of complete and partial hydatidiform moles

Article Abstract:

A hydatidiform mole is a cystic mass resulting from proliferation of the trophoblast, a cell layer that contributes to the formation of the placenta. There are two types of moles, complete and partial. Partial moles have evidence of a fetus, but complete moles do not. The complete mole is thought to originate from the doubling of a haploid genome, while the partial mole has a triploid chromosomal constitution. Malignant disease may occur with complete moles, but rarely occurs with partial moles. This study examined the risk factors for both types of moles to see if there were similarities or differences between the two. Questionnaires were given to 139 women who had complete moles, 49 who had partial moles, and 410 obstetric controls. Information regarding personal characteristics, medical history, and drug use was obtained. Moles were significantly more frequent in women who had borne no prior children than in those that had, with risk for hydatidiform mole decreasing as the number of prior births increased. Women reporting spontaneous miscarriages also had a greater risk for mole. Women reporting infertility problems had an increased risk for complete or partial mole. Age was not shown to be a risk factor. The risk for complete or partial mole was increased for women who had a history of gestational trophoblastic disease. Women having complete mole were more likely to have family histories of gestational trophoblastic disease than control subjects. None of the women with partial mole had positive family histories. Smoking was significantly associated with complete and partial mole. These findings suggest that there are similarities in the risk factors for complete and partial mole. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Causes of, Trophoblast, Trophoblasts, Cysts, Molar pregnancy, Hydatidiform mole

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Does standing up improve the predictive value of the supine pressor test for gestational hypertension?

Article Abstract:

Pregnant women whose blood pressure increases beyond a certain level when they turn from their sides to their backs (the supine pressor or roll-over test) have been considered at higher risk for developing hypertension during pregnancy (gestational hypertension). However, it is possible that other postural changes that are also associated with blood pressure elevation are more accurate predictors of gestational hypertension. To test this, 56 women pregnant for the first time were tested with both the supine and stand-up pressor tests; they were 28 to 32 weeks into their pregnancies. For the stand-up test, women moved from lying on their sides to standing up for 10 minutes. Patients' blood pressure scores were considered positive if the average diastolic level (measured during the heart's resting phase) rose 20 millimeters of mercury, or more, after the position change. Subjects were followed throughout pregnancy, delivery, and the period after delivery. Twenty of these patients developed gestational hypertension. The sensitivities of the roll-over and stand-up tests (number of true positive results divided by the sum of true positives and false negatives) were 10 and 30 percent, respectively. They did not differ with respect to specificity, false negatives, or predictive value. It appears that the pressor effects of the tests are mediated differently, since no subject had positive scores on both tests. The stand-up test had significantly higher sensitivity than the roll-over test, and might have had even more if different criteria for diastolic change had been selected. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Hypertension in pregnancy, Gestational hypertension

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Successful use of gamete intrafallopian transfer does not reverse the decline in fertility in women over 40 years of age

Article Abstract:

Many women are postponing their first pregnancy for various socioeconomic factors, and more women 40 years of age and older are seeking medical advice concerning infertility. Gamete intrafallopian transfer (GIFT) is an assisted reproductive technique for treating women with persistent infertility who have at least one functional fallopian tube. Most studies examining the effectiveness of GIFT compare women below and above age 35 years. Since more women older than 40 years are seeking infertility care, the results of GIFT should be specifically assessed in infertile women aged 40 years and older. The success of GIFT was evaluated in 59 women, aged 40 years and older, who underwent 122 GIFT cycles. Of 73 tubal transfers, seven resulted in clinical pregnancies, producing a rate of 9.6 percent per transfer. This rate is much lower than the 27.3 percent clinical pregnancy rate per transfer in women younger than 40 years of age. Thus, women aged 40 years and older should be made aware of the decrease in success rate of GIFT and other reproductive technologies with increased age. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Infertility, Female, Female infertility, Gamete intrafallopian transfer

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