title: Multiple pregnancies with complete mole and coexisting normal fetus in North and South America: A retrospective multicenter cohort and literature review.
abstract: OBJECTIVE
  To determine the clinical characteristics of multiple gestation with complete mole and coexisting fetus (CHMCF) in North and South America.
  
  
  METHODS
  Retrospective non-concurrent cohorts compromised of CHMCF from New England Trophoblastic Disease Center (NETDC) (1966-2015) and four Brazilian Trophoblastic Disease Centers (BTDC) (1990-2015).
  
  
  RESULTS
  From a total of 12,455 cases of gestational trophoblastic disease seen, 72 CHMCF were identified. Clinical characteristics were similar between BTDC (n=46) and NETDC (n=13) from 1990 to 2015, apart from a much higher frequency of potentially life-threatening conditions in Brazil (p=0.046). There were no significant changes in the clinical presentation or outcomes over the past 5 decades in NETDC (13 cases in 1966-1989 vs 13 cases in 1990-2015). Ten pregnancies were electively terminated and 35 cases resulted in viable live births (60% of 60 continued pregnancies). The overall rate of gestational trophoblastic neoplasia (GTN) was 46%; the cases which progressed to GTN presented with higher chorionic gonadotropin levels (p=0.026) and higher frequency of termination of pregnancy due to medical complications (p=0.006) when compared to those with spontaneous remission.
  
  
  CONCLUSIONS
  The main regional difference in CHMCF presentation is related to a higher rate of potentially life-threatening conditions in South America. Sixty percent of the expectantly managed CHMCF delivered a viable infant, and the overall rate of GTN in this study was 46%. Elective termination of pregnancy did not influence the risk for GTN; however the need for termination due to complications and higher hCG levels were associated with development of GTN in CHMCF.
authors.affiliation: University of Sao Paulo Trophoblastic Disease Center, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Lin
authors.affiliation: Botucatu Trophoblastic Disease Center, Clinical Hospital of Botucatu Medical School, Sao Paulo State University, Botucatu, Sao Paulo, Brazil.
authors.forename: Izildinha
authors.initials: I
authors.lastname: Maestá
authors.affiliation: Rio de Janeiro Trophoblastic Disease Center, (Maternity School of Rio de Janeiro Federal University, Antonio Pedro University Hospital of Fluminense Federal University, Maternity Ward of Santa Casa da Misericórdia do Rio de Janeiro), Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Braga
authors.affiliation: Sao Paulo Hospital Trophoblastic Disease Center, Paulista School of Medicine, Sao Paulo Federal University, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Sue Y
authors.initials: SY
authors.lastname: Sun
authors.affiliation: University of Sao Paulo Trophoblastic Disease Center, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Koji
authors.initials: K
authors.lastname: Fushida
authors.affiliation: University of Sao Paulo Trophoblastic Disease Center, University of Sao Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
authors.forename: Rossana P V
authors.initials: RPV
authors.lastname: Francisco
authors.affiliation: New England Trophoblastic Disease Center, Donald P. Goldstein MD, Trophoblastic Tumor Registry, Boston, MA, USA; Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA; Dana Farber Cancer Institute, Boston, MA, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Elias
authors.affiliation: New England Trophoblastic Disease Center, Donald P. Goldstein MD, Trophoblastic Tumor Registry, Boston, MA, USA; Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA; Dana Farber Cancer Institute, Boston, MA, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Horowitz
authors.affiliation: New England Trophoblastic Disease Center, Donald P. Goldstein MD, Trophoblastic Tumor Registry, Boston, MA, USA; Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA; Dana Farber Cancer Institute, Boston, MA, USA.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Goldstein
authors.affiliation: New England Trophoblastic Disease Center, Donald P. Goldstein MD, Trophoblastic Tumor Registry, Boston, MA, USA; Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, MA, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA; Dana Farber Cancer Institute, Boston, MA, USA. Electronic address: rberkowitz@partners.org.
authors.forename: Ross S
authors.initials: RS
authors.lastname: Berkowitz
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000022:Abortion, Spontaneous / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D006063:Chorionic Gonadotropin / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death; D006801:Humans; D006828:Hydatidiform Mole / Q000097:blood / Q000453:epidemiology*; D006980:Hyperthyroidism / Q000453:epidemiology; D050498:Live Birth / Q000453:epidemiology; D009511:New England / Q000453:epidemiology; D009656:North America; D011225:Pre-Eclampsia / Q000453:epidemiology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000097:blood / Q000453:epidemiology*; D011272:Pregnancy, Multiple; D059285:Pregnancy, Twin; D047928:Premature Birth / Q000453:epidemiology; D012128:Respiratory Distress Syndrome / Q000453:epidemiology; D012189:Retrospective Studies; D013020:South America; D014592:Uterine Hemorrhage / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000097:blood / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin
keywords: Gestational trophoblastic disease; Hydatidiform mole; Multiple, Pregnancy; Near miss, healthcare; Pregnancy, Twin; Trophoblastic neoplasms