par Flici, O;Tadjerouni, A.;Robyn, Claude
Référence Journal de gynécologie obstétrique et biologie de la reproduction, 13, 1, page (67-76)
Publication Publié, 1984
Article révisé par les pairs
Résumé : This paper starts with a short description of the history of the discovery of the hydatidiform mole (Tulp in 1641) and of the treatment (before 1956, hysterectomy in most cases). After 1961 chemotherapy started to be used even in patients who had cerebral metastases. 72 patients who had attended Professor Hubinont's department in the University Hospital of Saint-Pierre in Brussels between January 1971 and December 1981 were followed up. Questionnaires were sent to the patients and to their doctors who were treating them in order to find out what had happened in subsequent pregnancies and what the maternal and fetal consequences and complications were. The social class and the marital status of the patients was also considered as well as their wish to become pregnant again. Of the 72 cases that were followed up, 63 (87.5%) recovered while 9 (12.5%) had clinical, biological or radiological signs of persistent non-metastatic (3) and metastatic (6 cases) active disease. The department asked patients not to become pregnant in the year following removal of the mole. 10% were sterilised, 4 by hysterectomy and 4 by tubal ligation. 42% used the oral contraceptive pill and 34% (24 cases) condoms. Patients who became pregnant were compared with a group of 2,529 pregnancies in Saint-Pierre Hospital during the year 1981. 44 out of the 72 patients who were followed up after hydatidiform mole became pregnant with a total of 52 pregnancies. Ten became pregnant in the first 6 months, 11 between 6 and 12 months and 23 after a delay of 12 months. Out of the 52 pregnancies, 34 (65%) had a live baby at term. 6 were premature and 31 out of 34 babies delivered at term were delivered vaginally and 3 by Caesarean. There were 9 spontaneous abortions (17%) and 2 terminations of pregnancy (4%). Three patients had repeated non-intentional abortions and one had a still-birth for which the cause could not be found. Only one other had a second mole. When these results are compared with the histories of these patients before they had the hydatidiform mole there did not seem to be any increase in the number of spontaneous abortions or premature labours, nor was there when this group was compared with a control group. Only one of the 38 live-born children showed a major congenital abnormality which was varus equinus. There was no possibility of picking out statistically anything of value as far as congenital malformations was concerned. The discussion is concerned with the speed of return of normal ovulatory cycles after a hydatidiform mole has been removed and fertility after treatment resulting in cure. The discussion also deals with the subject of recurrences of the mole and the fertility found after malignant degeneration of the mole. It is clear that whether the patients were treated with simple removal of the mole or with therapy as well (9 patients, i.e. 12.5%) those who became pregnant had the expected number of deliveries at or near term and the figures for normal healthy children were the same as in the control population. The authors' observations confirm the facts in the literature and demonstrate that there are no secondary effects of chemotherapy either for the patient or for the genetic outcome of her oocytes.