Natural history of twin pregnancy with complete hydatidiform mole and coexisting fetus

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Citations from the Lirerarure/Int.

High-dose oxytocio: 24Lversts40-min dosage interval Satin A.J.; Leveno K.J.; Sherman L.; Mcintire D. USA

OBSTET GYNECOL 1994 83/2 (234-238) Objective: To determine whether an increase in the oxytocin dosing interval would decrease the incidence of uterine hyperstimulation. Methods: This study included 1801 consecutive pregnancies receiving high-dose oxytocin. Oxytocin was used for labor augmentation in 1167 and induction in 634 women. Twenty- and 40&n dosage intervals were compared. The study period was based on an 80% likelihood of detecting 5 and 10% differences in the cesarean and hyperstimulation rates, respectively. Statistics were analyzed with x2, Fisher, and Wiicoxon rank-sum tests where appropriate. Multivariate logistic regression and analysis of covariance were used to control for confounding demographic variables. Results: Comparison of the 20- and 40-min regimens for labor induction yielded no differences in the rates of cesarean delivery for dystocia (I6 vs. 19%) or fetal distress (5 vs. 6%). The 20-min regimen for augmentation was associated with a significant reduction in cesarean for dystocia (8 vs. 12%; P = 0.05). The incidences of uterine hyperstimuiation was greater with the 20-min than the 40-min regimen for induction (40 vs. 31%; P = 0.02), but not for augmentation (31 vs. 28%). Neonatal outcomes were unaffected by the dosage interval for both augmentation and induction. Conclusions: A 40-min dosing interval for high-dose oxytocin offers no clear advantage over a 20-min interval. Both regimens were safe and efficient, with no differences in perinatal outcome. The 20-min interval was associated with fewer cesareans for dystocia when used for labor augmentation, whereas the 40min interval resulted in less hyperstimulation when used for labor induction. Incrementalinereasesin oxytocio infusion regimensfor induction of Iabor at term in primigrnvidas:A randomizedcontrolled trial Orhue A.A.E. NGA

OBSTET GYNECOL 1994 8312 (229-233) Objective: To compare induction of labor by intravenous oxytocin in regimens increasing incrementally at 15- and 30min intervals. Methods: in a randomized controlled trial, 124 primigravidas requiring induction of labor by oxytocin infusion were randomly allocated to incremental increases at 30-min intervals (62 patients) or 15-min intervals (62 patients). The main outcomes assessed were mode of delivery, complications of labor and delivery (precipitate labor, hyperstimulation, postpartum hemorrhage, perineal tears, puerperal pyrexia), and number of days in the hospital. Results: The 30-min incremental regimen resulted in less precipitate labor (odds ratio 0.233, 95% confidence interval [CI] 0.042-0.55, x2 = 4.133), less uterine hyperstimulation (odds ratio 0.17, 95% CI 0.015-1.906), and reduced length of stay in the hospital (difference in medians 3 days, 95% CI for difference in medians 2-4 days). The induction-delivery interval was longer with 30 min (median 8 h) than with 15 min (median 5 h) (difference in medians 2 hours, 95% CI for difference in medians O-3 h). With the 30-min interval, there was a reduction in the occurrence of postpartum hemorrhage, perineal tears, and puerperal pyrexia,

J. Gynecol. Obstet. 47 (1994) 83-91

but these differences did not reach statistical significance. Conclusions: For the induction of labor in primigravidas, 30-min incremental increases in the infusion rate of oxytocin were superior to a i5-min incremental protocol in reducing the incidence of hyperstimulation and precipitous labor. Natural history of twin pregnancy with complete hydatidiform mole and coexisting fetus Steller M.A.; Genest D.R.; Bernstein M.R.; Lage J.M.; Goldstein D.P.; Berkowitz R.S. USA

OBSTET GYNECOL 1994 83/l (35-42) Objective: To investigate the clinical features and natural history of twin conceptions consisting of complete hydatidiform mole and a coexisting fetus. Methods: Since 1973, eight welldocumented cases of twin pregnancy with complete hydatidiform mole and coexisting fetus have been treated at the New England Trophoblastic Disease Center (NETDC). The clinical features of these eight patients were compared to 71 patients with singleton complete hydatidiform mole treated at the NETDC and with the published experience of other investigators. Flow cytometric analysis of DNA content was performed in addition to histologic inspection to assist in confirming the diagnosis of twin pregnancy with complete hydatidiform mole and coexisting fetus. Results: Five of the eight patients in this series developed persistent gestational trophoblastic tumor requiring chemotherapy. Three of these five patients developed metastases requiring multi-agent chemotherapy to achieve remission. The presenting symptoms of twin pregnancy with complete hydatidiform mole and coexisting fetus were similar to those in patients with a singleton complete mole. However, compared to singleton complete molar gestation, a twin pregnancy with complete mole and coexisting fetus was diagnosed at a later gestational age, had higher preevacuation &hCG levels, and had a greater propensity to develop persistent gestational trophoblastic tumor. Conclusions: Our findings indicate that patients with complete hydatidiform mole and coexisting fetus are at high risk for developing persistent gestational trophoblastic tumor. Alternating weekly cbemotberapywitb etoposide-metbotrexatedactinomycillleycIopbospbamide-viocristine for high-risk gestational trophobhtsticdisease Soper J.T.; Evans A.C.; Clarke-Pearson D.L.; Berchuck A.; Rodriguez G.; Hammond C.B. USA

OBSTET GYNECOL 1994 83/l (I 13-l 17) Objective: To evaluate the response rate and toxicity of alternating weekly therapy with etoposide-methotrexatedactinomycin/cyclophosphamide-vincristine for women with high-risk gestational trophobiastic disease. Methods: Twentytwo women with gestational trophoblastic disease received 126 cycles of the study regimen. Response was evaluated by serial hCG monitoring. Toxicity was assessed using standard criteria. Results: Six women (27%) were treated for primary therapy and 16 (73%) for secondary therapy. The median prognostic index score was I I (range 7-19). Only 23% of the patients and 11% of the 126 treatment cycles had grade 4 neutropenia, despite the