الفهرس 
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Abstract
Background: Hydatidiform mole is the most common type of gestational trophoblastic disease and may be complete or partial. It is a human pregnancy characterized by excessive trophoblastic proliferation and abnormal embryonic development that may be sporadic or recurrent. Recurrent hydatidiform mole is a rare genetic disorder defined by the occurrence of at least two molar pregnancies in the same patient. The frequency of RHMs in England has been reported by Sebire et al to be 1% to 2%. However, higher frequencies of RHMs have been reported from the Middle and Far East, where it ranges from 2.5% to 9.4%. Mutations in two genes NLRP7 and KHDC3L are found causative of recurrent molar pregnancies. NLRP7 is mutated in about 48 to 80 % of RHM. Incidence, risk factors, outcome and NLRP7 gene status of recurrent hydatidiform mole may differ from one country to another. Objective. To investigate risk factors, reproductive history, outcome and NLRP7 gene status in RHM patients at GTD clinic, Mansoura University Hospital. Methods. An observational prospective study was conducted at the GTD Clinic of Mansoura University. The patients were recruited for 12 months from 1/4/2018 to 31/3/2019. The patients’ characteristics, reproductive history, outcome and NLRP7 gene status were reported. Results. Twenty-five cases of recurrent hydatidiform mole were reported. Mean age of the studied cases was 29.56years ±4.60SD. Nineteen cases (76%) were nulliparous. Percentage of the cases with previous history of miscarriage was 20.0%. Medical history of hypertension was observed in four cases (16%). Four cases of FRHM with a history of consanguinity between the patients’ parents were reported. Variability in number of RHMs was noticed, the least was 2 (28%) and the highest was 14 (4%). Recurrent complete hydatidiform moles were reported in 13 cases (52%) while recurrent partial moles were reported in 3 cases (12%). Rate of GTN progression after complete and partial moles was 28% and 4% respectively. NLRP7 gene mutation was reported in 13 cases (100%). Three sisters who represent obvious familial cases and another apparently sporadic ten cases of RHM. Twelve variants of NLRP7 gene were previously reported. A Novel autosomal recessive NLRP7 mutation in an Egyptian family with BiHM was reported. Viable term pregnancy was achieved in 5 cases (20%) during follow up while 11cases (44%) resulted in molar pregnancy. Poor reproductive outcome was reported in positive NLRP7 gene mutation patients as viable term pregnancy was achieved in one case only. Conclusion. Recurrent molar pregnancy appears to involve 10% of subsequent pregnancies as 250 hydatidiform mole cases were recruited in the period between September 2015 and April 2019, 25 RHM cases were recruited in the same period. RHM is associated with a more aggressive clinical course and increased incidence of malignancy in subsequent hydatidiform moles. For two consecutive episodes of molar pregnancy, subsequent molar pregnancy risk rises to 44%. Prior molar pregnancy, type of the preceding mole (CHM), Nulliparity, parent consanguinity and family history of similar conditions are considered risk factors implicated in the causation of RHM. NLRP7 gene was mutated in 100% of RHM patients with associated poor reproductive outcome.