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1. GUIDELINE TO hCG LEVELS DURING PREGNANCY
hCG LEVELS IN WEEKS FROM LMP (GESTATIONAL AGE)
 3 weeks LMP: 5 – 50 mIU/ml
 4 weeks LMP: 5 – 426 mIU/ml
 5 weeks LMP: 18 – 7,340 mIU/ml
 6 weeks LMP: 1,080 – 56,500 mIU/ml
 7 – 8 weeks LMP: 7, 650 – 229,000 mIU/ml
 9 – 12 weeks LMP: 25,700 – 288,000
mIU/ml
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 13 – 16 weeks LMP: 13,300 – 254,000 mIU/ml
 17 – 24 weeks LMP: 4,060 – 165,400 mIU/ml
 25 – 40 weeks LMP: 3,640 – 117,000 mIU/ml
 Non-pregnant females: <5.0 mIU/ml
 Postmenopausal females: <9.5 mIU/ml

2. USG FINDING
 Snow storm appearance.
 Absence of fetal shadow in a complete molar
pregnancy.
 The placenta shows scattered cysts.
 The metastasis in the liver can be picked up on
ultrasound scan.
 Doppler ultrasound shows abnormal
vascularization.
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3. DIFFERENTIAL DIAGNOSIS
 Threatened abortion
 Ectopic pregnancy
 Local causes of bleeding
 Twin pregnancy
 Fibroid uterus
 Trisomy, Monosomy, Maternally Triploidy and Translocation
 Turner Syndrom, Edward Syndrom, Beckwith Wiedemann sydrom
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4. COMPLICATIONS OF GTDs
 Hyperemesis gravidarum, pregnancy-induced hypertension.
 Haemorrhage, anaemia.
 Infection.
 Thyroid storm—3%.
 Embolization with acute pulmonary insufficiency and Coagulation failure—2%.
 Uterine perforation—spontaneous but more commonly during suction evacuation.
 Delayed—recurrent mole and choriocarcinoma.
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5. MANAGEMENT OF BENIGN GTDs
 Suction evacuation in majority of the cases.
 Hysterectomy if life threatening haemorrhage during suction evacuation.
 Chemotherapy if indicated.
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6. INDICATIONS FOR INITIATING CHEMOTHERAPY
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7. EVACUATING A MOLAR PREGNANCY
 Suction Evacuation is method of choice can be done by conventional suction curettage as
well as by MVA
 Two MVA set should be available
 Cervical preparation with prostaglandins or misoprostol , should be avoided to reduce the
risk of embolization.
 For Partial mole: It depends on the fetal parts
 Small fetal parts :Suction curettage
 Large fetal parts: Medical (oxytocics)
 In partial mole the oxytocics is safe ,as the hazard to embolise and disseminate trophoblastic
tissue is very low.
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8. EVACUATING A MOLAR PREGNANCY
 Blood should be cross matched and kept available
 Maintain two i/v line
 Procedure to be carried out in OT
 Cervical os to be dilated up to 12mm size suction cannula.
 Deep insertion of suction cannula avoided
 USG Guided Gentle curettage is performed after evacuation is complete and tissue sent for
histopathology.
 The use of oxytocin infusion prior to completion of evacuation is not recommended
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9. CANULA UP TO A MAXIMUM OF 12 MM, IS USUALLY SUFFICIENT TO
EVACUATE ALL COMPLETE MOLAR PREGNANCIES
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10. THE MOLAR CONTENT FOR HISTOPATHOLOGICAL EXAMINATION
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