1/7. Partial mole, triploidy and proteinuric hypertension: two case reports.We present two cases of proteinuric hypertension in the early second trimester of pregnancy, associated with partial mole and triploidy karyotyping. This demonstrates the complementary nature of ultrasound in the diagnosis and management of this rare association.- - - - - - - - - - ranking = 1keywords = triploidy (Clic here for more details about this article) |
2/7. Preeclampsia and fetal triploidy: a rarely reported association in nephrologic literature.We report a case of a healthy woman - whose previous pregnancy was uncomplicated - with early onset of hypertension, proteinuria and edema, during her second pregnancy. Ultrasound examination at 19th week of amenor rhea showed a fetus with growth retardation, corresponding to 17 weeks' gestation, ascites, cardiomegaly with serious multiple congenital anomalies. amniocentesis for fetal karyotyping revealed 69, XXX. Because of continued elevated blood pressure, increasing proteinuria and severe lethal fetal anomalies, interruption of pregnancy was suggested. It was subsequently carried out by surgery. The patient underwent renal biopsy 10 days post-partum: histology showed the presence of the characteristic pathologic renal changes of preeclampsia. A year later, she became pregnant by the same partner. The third pregnancy was uneventful. The combination of fetal triploidy and preeclampsia may suggest a causative relationship. Clinically, most cases manifest as severe early-onset preeclampsia and must be differentiated from essential hypertension and a chronic glomerulonephritis (GN), which becomes symptomatic during pregnancy. When a fetus has triploidy, the counseling should stress the high incidence of preeclampsia; particularly when fetal anomaly is not compatible with life, it is well known that delivery of the fetus is curative in this syndrome. This information is important in counseling patients who are hesitant to terminate the pregnancy purely for a fetal abnormality, even if lethal.- - - - - - - - - - ranking = 1.2keywords = triploidy (Clic here for more details about this article) |
3/7. Marked abnormal quadruple screen in a patient with severe preeclampsia at 20 weeks with a triploid fetus.Severe preeclampsia rarely occurs prior to 20 weeks of gestation except in pregnancies with triploidy. The patient reported herein is a 29-year-old primigravida who developed severe preeclampsia at 20 weeks of gestation. Evaluation of the pregnancy demonstrated a markedly abnormal quadruple screen. amniocentesis demonstrated a fetus with triploidy, despite a normal appearance.- - - - - - - - - - ranking = 0.4keywords = triploidy (Clic here for more details about this article) |
4/7. A case of "pure" preeclampsia with nephrotic syndrome before 15 weeks of gestation in a patient whose renal biopsy showed glomerular capillary endotheliosis.A 35-year-old Japanese woman for whom a previous health checkup showed normal blood pressure and urinalysis results without serological abnormalities developed nephrotic syndrome with severe hypertension at 15 gestational weeks. The renal biopsy performed at 17 weeks of gestation showed severe glomerular capillary endotheliosis. By means of electron microscopy, no electron-dense deposits were observed in glomeruli, and foot-process arrangement was normal. Histological findings indicated the patient's glomerular damage was caused by the mechanisms of preeclampsia. The patient underwent an elective abortion at 18 weeks of gestation. Clinical abnormalities vanished completely within 3 months after the elective abortion, which provided additional evidence that proteinuria and hypertension were caused purely by pregnancy. In general, the term preeclampsia refers to new onset of hypertension and proteinuria after 20 weeks of gestation. When proteinuria or hypertension is newly observed before 20 weeks of gestation, they are practically associated with triploidy, trophoblastic disease, or antiphospholipid syndrome. However, our case was not associated with them. Therefore, we called this case "pure" preeclampsia. We confirm the notion for the first time that preeclampsia associated with glomerular capillary endotheliosis can occur before 20 weeks of gestation. In addition, this report describes the earliest onset of preeclampsia compared with previously published reports. We also discuss causes of preeclampsia in early gestation and refer to the issue of the application of renal biopsies during pregnancy.- - - - - - - - - - ranking = 0.2keywords = triploidy (Clic here for more details about this article) |
5/7. Early-onset preeclampsia, triploidy and fetal hydrops.Early-onset preeclampsia (16-24 weeks) is frequently associated with fetal and placental anomalies. hydatidiform mole, fetoplacental triploidy with partial molar changes and idiopathic hydrops fetalis are commonly associated ones. Two patients had severe, early-onset preeclampsia and ultrasonically documented fetal anomalies, one fetal triploidy, the other idiopathic hydrops with normal karyotype. The management of early-onset preeclampsia benefits from ultrasonography, and an aggressive search for fetal anomalies is recommended. Seventy-two percent of cases of early-onset preeclampsia in our institution were associated with significant fetal and placental malformations. An immunologic basis of the preeclampsia in these cases seems likely but remains unproven.- - - - - - - - - - ranking = 1.2keywords = triploidy (Clic here for more details about this article) |
6/7. Triploid partial molar pregnancy detected through maternal serum alpha-fetoprotein and HCG screening.BACKGROUND: Screening for down syndrome using maternal serum alpha-fetoprotein (MSAFP) and hCG, with or without unconjugated estriol (E3), has become standard practice in much of the united states. When both MSAFP and hCG are elevated, the possibility of a partial molar pregnancy with fetal neural tube or abdominal-wall defect should be added to the differential diagnosis, as illustrated by this case. CASE: A 22-year-old woman had elevated MSAFP and hCG levels on routine screening at 16 weeks' gestation. Ultrasound examination suggested a neural tube defect and a thickened placenta. amniocentesis was performed. She very rapidly developed preeclampsia. fluorescence in situ hybridization showed three distinct spots for the three probes tested. A triploid karyotype was confirmed with standard cytogenetic analysis. The fetus had an open neural tube defect, and placental pathology was consistent with a partial hydatidiform mole. CONCLUSIONS: A possible partial molar pregnancy with abdominal-wall or open neural tube defect should be added to the differential diagnosis for interpreting down syndrome screens when both MSAFP and hCG are elevated. A presumptive diagnosis of triploidy using fluorescence in situ hybridization was important in the management of this pregnancy.- - - - - - - - - - ranking = 0.2keywords = triploidy (Clic here for more details about this article) |
7/7. A non-trophoblastic tumor co-existing with a triploid fetus.Non-trophoblastic neoplasms are the most frequent, benign tumors of the placenta, occurring in approximately 1% of all placentas examined. A case is described of a 24-year-old woman who presented with severe, early-onset pre-eclampsia, high human chorionic gonadotropin (hCG) levels, and a triploid fetus and who was found to have a small choriohemangioma. The woman, gravida 2 para 1, was referred to our hospital for perinatal evaluation. The fetus, gestational age 18 weeks 3 days, had fetal growth restriction with multiple congenital anomalies. The fetal karyotype was 69,XXY. Compared with the normal range for this gestational age, the beta-hCG level was significantly elevated (1,054,000 mIU/ml) as was the maternal serum alpha-feto-protein measurement (539.1 ng/ml). Sonographically, the placenta appeared hydropic, irregularly shaped, and gelatinous. A suction dilatation and evacuation under sonographic guidance was performed. Histological examination of placental tissue revealed hydropic degeneration of the chorionic villi. The specific histological features of a partial molar pregnancy were not present. However, there were changes consistent with a choriohemangioma. Flow cytometric dna analysis performed on formalin-fixed, paraffin-embedded tissue blocks of placenta showed triploidy. Immunohistochemical staining with human placental alkaline phosphatase was consistent with a hydropic degeneration pattern. We conclude, first, that triploidy does not always imply the presence of a partial mole. Second, the dictum, that pre-eclampsia, if it occurs under 20 weeks' gestation, must be associated with a molar pregnancy, may not hold when placental aneuploidy is present. Although the findings in this pregnancy could have been incidental, there may be an association between a choriohemangioma and polyploidy.- - - - - - - - - - ranking = 0.4keywords = triploidy (Clic here for more details about this article) |