| Objective: With the availability of transvaginal ultrasound and human chorionic gonadotropin(h CG),The diagnosis of complete hydatidiform mole(CHM)is typically made in the first trimester,rather than in the second trimester,which makes the difficulty of correct diagnosis due to the lack of typical sonographic features in the early pregnancy.In our study,we revealed sonographic changes of CHM over the time of the first trimester in a large cohort study,to improve the knowledge of early CHM.Methods: This retrospective study was performed on 450 cases(686 ultrasound files before evacuation)of histologically proven CHM in the first trimester(≤97 days)in Women’s Hospital,School of Medicine,Zhejiang University from January 2014 to May 2020.They were divided into 5 groups according to the gestational age on the day of the ultrasound exam: 28-41 days(n=33),42-55 days(n=209),56-69 days(n=327),70-83 days(n=93),84-97 days(n=24).The clinical data(age,gestational age,gravidity and parity,initial symptoms,the serum h CG level)were recorded,as well as the sonographic features,including the size of the uterus and intrauterine heterogeneous echo mass,embryo sac(the thickness of the chorionic membrane,chorionic bumps,yolk sac,embryo-like echo,and fetal heart),vesicular sign,color doppler flow imaging(CDFI),lutein ovarian cyst.ultrasound classification:According to the presence of a gestational sac-like feature or not,it is divided into type I(gestational sac)and type II(non-gestational sac-intrauterine heterogeneous echogenic mass).According to the variety of the ultrasonographic morphology of the internal sac wall,Type I was further classified into Type Ia(the smooth wall),Ib(the irregular wall and chorionic bumps<3mm in height),Ic(chorionic bumps≥3mm in height,Maximum Area of chorionic bumps/Maximum Area of gestational sac≤0.5),and Id(Maximum Area of chorionic bumps/Maximum Area of gestational sac>0.5).Type II was further classified into IIa(non-honeycomb-like echo)and IIb(honeycomb-like echo)based on the presence of a vesicular sign or not.Results: 1.The mean age of patients was 30.7 years(range,14-54 years).The mean gestational age at the first ultrasound examination of this pregnancy was 59.3days(range,30-97 days).Vaginal bleeding(57.3%,258/450)was the most common initial symptom,and 36.4%(164/450)had no abnormal clinical manifestations.The mean maximum pre-evacuation blood h CG was 158,017 IU/L(range,6,314-806,883IU/L),54.4%(373/686)had serum h CG less than 100,000 IU/L,and 45.6%(313/686)had serum h CG more than 100,000 IU/L.2.There were a series of atypical ultrasound features in CHM in early pregnancy,while typical ultrasound features are uncommon: 43.0%(295/686)showed gestational sac-like echo,14.6%(43/295)showed yolk sac echo,4.4%(13/295)showed embryo-like echo,72.5%(214/295)showed chorionic bumps,and 17.3%(119/686)showed blood flow signal.vesicular sign accounted for 85.0%(including a small amount of 30.8%,and a large amount of 54.2%),and lutein ovarian cyst accounted for only 0.1%(1/686).In addition,the appearance of chorionic bumps was earlier than that of vesicular signs,and the mean gestation age was 57 and 62 days,respectively.3.There were 6 types of CHM in the first trimester: 33(4.8%)were type Ia,48(7.0%)were type Ib,46(6.7%)were type Ic,168(24.5%)were type Id,116(16.9%)were type IIa,and 275(40.1%)were type IIb.4.The correct diagnosis rate of ultrasound for CHM in early pregnancy was47.5%,the descriptive diagnosis rate was 34.4%,and the misdiagnosis rate was18.1%.5.The sonogram features of CHM in early pregnancy evolved with the development of pregnancy: The main feature is the normal gestational sac-like echo during 28-41 days of gestation,and the sonographic types were mainly Ia(42.4%)and Ib(21.2%).The misdiagnosis rate of ultrasound before uterine evacuation was the highest(57.6%).After 42 days of gestation,the main sonographic feature was a chorionic bump with a small or large number of vesicles in the irregularly shaped gestational sac.The proportion of Ib-IIb types(13.4%-26.3%)was relatively uniform during 42-55 days of gestation,with complex sonographic features and the highest descriptive diagnostic rate(59.3%).After 56 days of gestation,the probability of recognizable gestational sac-like echoes was significantly reduced,and the main feature was an intrauterine heterogeneous echo mass with a large number of vesicles.The ultrasound classification was mainly type IIb(48%-91.7%),and the correct diagnosis rate(58.7%-80.6%)was significantly improved.Conclusion: 1.There were a series of atypical ultrasound features in CHM in early pregnancy,while typical ultrasound features are uncommon,and the correct diagnosis rate of ultrasound is low.2.The chorionic bump may be the first sonographic sign to identify CHM,and the vesicular sign is the most common sonographic feature of CHM in early pregnancy.3.The sonogram features of CHM in early pregnancy evolved with the development of pregnancy(the gestational sac-like echo disappeared and the vesicular sign increased). |
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