It contains introduction, definition, risk , etiology, clinical manifestations, complications and management.
It's also known as v mole /vesicular mole/hydatidiformole /grape like structure etc..
The contain is taken from mostly DC DATTA , HIRALA KONAR.
All type of management is given inside like medical, surgical and nursing management.
Andheri East ^ (Genuine) Escort Service Mumbai ₹7.5k Pick Up & Drop With Cash...
Vesicular mole /Hydatidiform mole.pptx
1.
2.
3.
4.
5. DEFINITION
• It is an abnormal condition of the
placenta where there are partly
degenerative and partly
proliferative change in the young
chorionic villi
• The result in formation of cluster
of small cyst of varying size. it is a
type of benign neoplasia with
malignant potential.
• This is a type of gestational
trophoblastic disease
6. • It is and
abnormal
condition of the
placenta where
there are partly
degenerative and
partly
proliferative
change in the
young chorionic
villi
13. ETIOLOGY
• Unknown but some of the factor or
hypothesis put forward are :-
• 1) Prevalence teenage pregnancy or women
above 35 years.
• 2) Prevalence in some race and ethnic origin
(more in philipino, Japan less in USA, Europe)
• 3) Faulty nutrition (less protein, animal fat
,carotene etc)
• 4) Disturbed maternal immune mechanisms
14. Cont..
• 5) Seen in AB blood group as they have
not ABO antibody.
• 6) Cytogenetic abnormality
(chromosomal abnormality)
• 7) History of prior hydatidiform mole
15. CLINICAL FEATURES
• Women are usually teenage or adult with high parity.
• Patient come with history of 8 to 12 week of
amenorrhea.
• symptoms-
• Patient come with complaint of vaginal bleeding
suggestive of incomplete or threatened abortion.
• Blood looks like white currant in red currant juice (due
to gelatine substance from Rapture cyst)
• Patient also complain of lower abdominal pain (which
may due to overstretching of uterus or uterus
perforation or infection or uterine contraction To expel
16. Cont....
• Other symptoms are patient become sick
without any Apparent reason.
• Vomiting become excessive.
• Breathlessness due to pulmonary
embolism.
• Thyrotoxic features like tremor, tachycardia
may be present due to raised chorionic
thyrotropin.
18. Cont..
•Sign-
• features of pregnancy are evident.
•patient look very ill
• preeclampsia features are evident
19. Per abdomen examination
findings-
• 1 .The size uterus is more than period of
gestation.
• 2. The feel of uterus is firm and
Elastic(doughy) because no fetus, amniotic
fluid.
• 3. No fetal parts felt.
• 4 . No FHS heard
20. Vaginal examination
•- Internal ballottement cannot be
elicited .
•-Uni or bilateral elargement of ovary.
•- Vesicles may be found in vaginal
examination
•- If os is dilated blood clot and vesicles
are felt instead of membranes.
21. INVESTIGATI
ON
• CBC, ABO, Rh typing.
• LFT, KFT , thyroid profile.
• USG (snow storm appearance)
• Estimation of HCG >100,000mlIU/ml)
• X-ray abdomen- Negative fetal shadow.
• X-ray chest to rule out any pulmonary embolism or
metastasis
• CT/MRI not more required
• Definitive diagnosis after histological examination of
products evacuated.
25. MANAGEMENT
• Principle of management
• 1)Empty uterus by suction evacuation as
soon as diagnosis is made
• 2)Supportive therapy according to patient
condition and need (anaemia infection)
• 3)Counseling for regular follow up
26. Patient are divided into two group
•Group A:
•-Mole is in process of expulsion
• Group B:
•-uterus is inert
27. Supportive Therapy
• Put IV
• Collect blood and send for grouping and
cross matching
• Arrange for blood
• Start IV RL
• Start and antibiotics to prevent infection
28. Definitive management:
• Suction evacuation is most safe
and effective method even if 28
wks of gestation.so management
according to 2 groups
29. Management
• Group A:
• Cervix is favourable
• 1. suction evacuation
• 2. or Dilatation and evacuation
• 3. or digital exploration and removal of mole
by ovum forceps
• after evacuation injection methargine 0.2 mg
IM
30. • Group B:
• Cervix tubular &
closed
•
• 1)slow dilation by
laminaria tent,
followed by suction
evacuation
• 2) or vaginal Misoprost
PGE2 400 microgram 3
hours prior & suction
evacuation
31.
32. • Indication of hysterectomy
• 1.patient more than 35 yrs
• 2. patient completed family irrespective of
age
• 3 Uncontrol hemorrhage after surgery
• Indication for hysterotomy:
• 1. profuse vaginal bleeding
• 2.Cervix is unfavourable
• 3.Accidental perforation
35. FOLLOW UP
• All the case to followed up for at least 1
year.
• objective is to be diagnosed persistent
trophoblastic disease and
choriocarcinoma
36. Continue..
•Interval of follow up
• 1.every week till HCG is negative
• 2.once negative every month till 6
month.
•3. patient must not get pregnant
during follow-up .so advice well on
contraception
37. Follow up protocol
• during each visit patient should under go
• 1 .History taking especially enquire about
irregular vaginal bleeding, cough,
breathlessness
• 2. abdominal and pelvic examination
check for involution of uterus, size of
ovary , Malignant deposit in anterior
vaginal wall .
38. Cont...
• 3.investigation.
• a )detection of HCG in urine /serum till it
become negative.
• b) chest X-ray to be looked for sign of metastasis
• during follow of if following event happen then
we have to start chemotherapy for patient
39. • during follow of if following event happen then we have
to start chemotherapy for patient
• A.) if HCG HCG not falling Falling In stipulated time (10
to12 wk)
• B)If HCG is rising
• C)post evacuation bleeding
• D)when follow-up is not sure
• E) evidence of metastasis.
• F)Risk factors suggest chance of malignancy
• prophylactic chemotherapy may be also given in high
risk group and follow-up facility is poor.
40. Chemotherapy regimen
• injection Methotrexate 1mg/kg/ IM on
days 1,3,5 and 7 with folinic acid 0.1
mg/kg IM on days 2,4,6 and 8.
Repeated every 7 days. Total 3 courses
are given .
41. Contraceptive method
• The patient is traditionally advise not to be
pregnant for at least one year
• Thus if patient so Desire she of may be
pregnant after a minimum of six months
following the negative HCG titer
• use of contraception
42.
43. Bibliography
• DC DUTTA'S "text books of OBSTETRICS",9th
edition, published by jaypee,chap-16,pg no 181-
186
