Hydatiform Mole

(Molar Pregnancy)

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<Index>

 

Definition

-  Form of gestational trophoblastic disease

 

Features

-  Incidence 0.5-2/1000 of pregnancies

-  Most spontaneously miscarry

-  Recurrence

-  2% risk of 2nd

-  20% risk if x2 molars

 

 

Associated S/S

-  Lower abdominal pain

-  Vaginal bleeding

-  +/- passage of grape like material

-  Suspected pregnancy

-  Vomiting & nausea

-  May present w early onset pre-eclampsia (<20/40)

 

DDx

-  Hyperemesis gravidarum: US

 

Types

-  Partial

-  23X (maternal) + 46X/Y (paternal) = 69XXY

-  1% invasive

-  Rarely choriocarcinoma

-  Complete

-  46XX (paternal origin only)

-  10% invasive

-  3% choriocarcinoma

-  Invasive

-  Penetration into myometrium & blood vessels

-  May metastasise to lung, vagina, liver, brain, GIT

-  Spontaneous regression

-  Histological Dx

 

 

Ix

-  US: Dx: first or second trimester

-  +/- if invasive

-  DDx choriocarcinoma

-  Beta hCG

-  Elevated above dates

-  Also used to confirm successful Mx & resolution

-  Serial levels until 0

-  Blood Group + Rhesus

-  +/- CXR: lung mets of invasive mole

 

Mx

-  +/- Anti-D

-  D&C

-  Referral to reporting centre & F/U at tertiary centre

 

 

 

References

 

Pic (uterus): pregnan-cy.com/wp-content/uploads/2012/01/Molar-Pregnancy4.jpg

Pic (sperm + egg): www.medpedia.com/news_analysis/339-The-Lancet-Student-Blog/entries/45170-Gestational-trophoblastic-disease