Objective: To explore the safety of different termination methods of hydatidiform mole coexisting with a normal fetus in the second trimester of pregnancy. Design: A retrospective cohort study. Setting: A referral center for difficult and critical diseases in Obstetrics and Gynecology in China (Beijing). Population: Patients diagnosed hydatidiform mole coexisting with a normal fetus receiving termination of pregnancy in the second trimester (12 weeks to 27 +6 weeks). Methods: Data were extracted and summarized on the complications of different termination methods. Chi square analysis was used to explore the association of factors and complications. Main outcome measures: Volume of blood loss and progression to gestational trophoblastic neoplasm. Results: Different methods of terminating pregnancy in the second trimester of hydatidiform mole coexisting with a normal fetus were feasible, including forceps curettage, combination of mifepristone and misoprostol, intra-amniotic injection of rivanol, and cesarean section. The incidence of massive blood loss (over 300ml) was 50.0%. Molar tissues closer to the lower uterine segment than the fetus (P=0.035), and presence of complications (P=0.015) were the risk factors for massive blood loss during termination of pregnancy. The incidence of progression to gestational trophoblastic neoplasm was 35.7%. Conclusion: Different termination methods might lead to complications including massive blood loss and progression to gestational trophoblastic neoplasm. More medical measures should be taken to prevent and reduce the volume of bleeding among patients with high risk factors.

Objective: Intravenous leiomyomatosis (IVL) features histologically benign smooth muscle tumors growing within blood vessels. Although surgery is the primary treatment method, the rate of postoperative recurrence is high. This study aimed to analyze the risk factors for postoperative recurrence or progression of IVL and explore the impact of different treatment strategies on prognosis. Design: A retrospective cohort study of IVL patients who received surgical treatment was performed. Setting: A referral center for difficult and critical diseases in Obstetrics and Gynecology in China (Beijing). Population or sample: 114 IVL patients who received surgical treatment from January 2011 to December 2022 and received follow-up for ≥ 3 months were enrolled. Methods: Risk factors for postoperative recurrence or progression of IVL was analyzed by Kaplan‒Meier survival analysis. Sub-group analysis, including IVL confined to the uterus and para-uterine vessels, and IVL involving the iliac vein/genital vein and the proximal veins, was performed to explore impact of different treatment strategies on prognosis. Main outcome measures: The primary endpoint was recurrence (for patients with complete resection) or progression (for patients with incomplete resection). Results: The median follow-up time was 24 months (range 3-132 months). Twenty-nine cases (25.4%) recurred or progressed. The median recurrence or progression time was 16 months (range 3-60 months), and the median progression free survival time was not reached. Incomplete tumor resection (P=0.019), involvement of the iliac vein or genital vein (P=0.042), involvement of the inferior vena cava (P=0.025), and size of pelvic tumor ≥ 15 cm (P=0.034) were risk factors for recurrence and progression. For IVL confined to the uterus or para-uterine vessels, the postoperative recurrence rate after hysterectomy and bilateral oophorectomy was low. Compared to hysterectomy and bilateral oophorectomy, the recurrence risk after tumorectomy was significantly increased (P=0.009), and the recurrence risk after hysterectomy was marginally increased (P=0.058). For IVL involving the iliac vein/genital vein and the proximal veins, postoperative aromatase inhibitor treatment (P=0.889) and two-stage surgery (P=0.862) were not risk factors for recurrence on the premise of complete tumor resection. Conclusion: Incomplete tumor resection, extent of tumor lesions and size of the pelvic tumor were risk factors for postoperative recurrence and progression of IVL. For IVL confined to the uterus and para-uterine vessels, the recurrence rate after hysterectomy and bilateral oophorectomy was low. For IVL involving the iliac vein/genital vein and the proximal veins, aromatase inhibitor treatment after complete tumor resection did not reduce the risk of recurrence.