hydatidiform mole

1. HYDRATIDIFORM MOLE
SYN :VESICULAR MOLE

2. Introduction
It is an abnormal condition of the placenta where they are
partly degenerative and partly proliferative changes in the
young chorionic villi.
These result in the formation of the clusters of the small
cysts of varying size.

3. Introduction contd……
Because of its superficial resemblance to hydratid cyst, it is
named as hydratidiform mole.
It is best regardes as a benign neoplasia of the chorion with
malignant potential.

4. Incidence
There is a wide range of geographical and ethnic variation
of the prevalence of the condition . It is more common in
China, Indonesia ,Japan.
Highest in philippines-1 in 100 pregnancy
Lowest in European countries(USA)-1in 2000
Incidence in India –1 in 400

5. Classification

6. Classification
Partial mole
• Some fetal tissue ,blood vessels and villi present
Complete mole
• No fetal tissue , blood vessels and villi formation

7. Etiology
The cause is not definitely known ,but it appears to be
related to the ovular defect as it sometimes affects one ovum
of a twin pregnancy .however, the following faactors and
hypothesis have been forwarded:

8. Etiology contd..
Its prevalence is higher in teenagers and in women aged
beyond 35 years.
The prevalence appears to vary with race and ethnic group
Inadequate intake of protein , carotene and high intake of
animal fat specially in oriental countries.
Imbalance immune mechanism eg in hepatic disease rise in
gamaglobuline ,AB blood group.

9. Etiology contd.....
Cytogenetic abnormalities
The higher the ratio of paternal :maternal chromosomes,
the greater is the molar change . Complete mole show 2:1
ratio
History of prior hydratidiform mole increases the chance of
recurrence(1 to 4%).

10. pathophysiology
This Photo by Unknown author is licensed under CC BY.

11. Pathophysiology contd…..
Death of the ovum or failure of the embryo to grow is
essential to develop complete hydratidiform mole
The secretion from hyperplastic cells and transferred
substances from the maternal blood accumulate in the
stroma of the villi
Results in the distension of the villi to form vessicles

12. Pathophysiology contd……
The distension may also due to the edema and
liquification of the stroma
Vesicle fluid contain excessive hCH

13. Clinical feature
SYMPTOMS
Vaginal bleeding
Varying degree of lower abdominal pain
Constitutional symptoms:
a.patien become sick without any apparent reason

14. b. vomitting become excessive
c.breathlessness due to pulmonary embolism of trophoblastic
cell
Expulsion of grapes like vesicles per vagina is diagnose of
vesicle mole
History of quickening is absent

15. Sign
 Feature suggestive of early months of pregnancy are
evident
The patient look more ill than can be accounted for.
Pallor is usually prominent ,out of the proportion of the
visible blood loss

16. Feature of preeclampsia due to the hyperactivity of the
trophoblastic cells
Per abdomen :
The size of the uterus : larger
The feel of the uterus : firm elastic
Fetal parts: not palpable
Absence of fetal heart sound

17. Vaginal examination
Internal ballottement can not be elicited
Finding of the vesicles in the vaginal discharge
If cervical os is open, instead of membranes,blood clot or
the vesicles may be felt.

18. Investigations
Full blood count ,ABO and Rh typing
Hepatic ,renal and thyroid function are carried out
Sonography:
Qualitative estimation of chorionic gonadotrophin
 Straight X- ray abdomen
CT and MRI
Beta –hCG estimation

19. Differential diagnosis
 Threatened abortion
Fibroid or ovarian tumor with pregnancy
 Multiple pregnancy

20. Complication
 Haemorrhage and shock due to vaginal bleeding over a
time
 Sepsis – inccrease the chances of ascending infection due
to blood clot ,vaginal bleeding and absence of fetal
membrane
Uterine perforation – due to invasive mole or surgical
procedure

21. Complication contd…..
Gestational trophoblastic disease – it may develop
persistently elevated beta –hCG and may lead to
choriiocarcinoma
Recurrence – there are chances of recurrence of the mole in
subsequent pregnancies.

22. Management
The principle of management are :
 Supportive therapy to restore the blood pressure and
infection
Evacuation of the uterus as soon as diagnosis is made
Counselling for regular follow up to detect the persistent
trophoblastic disease

23. Management Contd…
1.supportive management
Group A – the patient usually presents with various amount
of bleeding :
 to starts a ringers solution I.V. infusion
Arrangement is made for blood transfusion

24. Management contd…
Group B- blood should also be kept ready prior to elective
evacuation of the uterus.

25. Management contd…...
2. Definitive management :
Suction evacuation (it is the treatment of choice
irrespective of the uterine size)
 suctioning with manual vacuum aspiration is safe, which
should be done rapidly. The risk of perforation is high in
using metal curettage.

26. Management contd…
 digital exploration and removal of the mole by ovum
forceps may helpful to evacuate the content of the uterus.
Infuse oxytocin 20 unit in 1 liter IV fluids (NS or RL) at 60
drops per minute to prevent hemorrhage once evacuation is
under way.
Administration of Rh ( D) immunoglobulin to women who
are Rh negative to prevent isoimmunization

27. Management contd……
 Hysterotomy : the procedure are rarely done. The
indications are;
 Profuse vaginal bleeding
Cervix unfavourable for immediate vaginal evacuation

28. Management contd…
Hysterectomy :this is indicated in;
Patient with age over 35
High risk patient with development of future malignancy
Female has completed her family irrespective of age
Perforating mole
Placental site trophoblastic tumor

29. Management contd….
2. Follow up management:
 Routine follow up is mandatory for all cases for at least 6
months following molar pregnancy.
 first B- hCG level is obtained 48 hours after evacuation
Then monitor serum hCG levels every weekly till they
become normal for three consecutive weeks.

30. Management contd….
 Once the hCG levels falls to a normal level for 3 weeks,
test the patient monthly for 6 months; then follow- up is
discontinued and pregnancy allowed.
 During the 6 month surveillance period, patient is advised
not to become pregnant.

31. Contraceptive advice
 Contractive of choice being combined oral pills
 IUD is contraindicated, because of its frequence
association of the irregular bleeding
Inj. DMPA can be used safely
 surgical sterilization is another alternative when family
size is complete