Molar pregnancies are a group of diseases caused by abnormal overgrowth of the placenta. There are benign and malignant types, with hydatidiform moles being benign tumors characterized by vesicular swelling of placental villi. Complete moles have no fetus and arise from an empty ovum fertilized by sperm, while partial moles may contain abnormal and defective fetal tissue. Symptoms include vaginal bleeding, nausea, and enlarged uterus. Diagnosis is made through elevated hCG levels and ultrasound findings. Treatment is surgical evacuation followed by monitoring of hCG levels to detect persistent trophoblastic disease, which may require chemotherapy.

1. MOLAR PREGNANCIES
Gaya

2. Group of diseases caused by over growth of
placenta
Types
–Benign
• Hydatidiform mole - complete
- Incomplete
–Malignant
• Gestational Choriocarcinoma
• Invasive mole ( chorioadenomadestruens)
• Placental site trophoblastic tumor

3. Hydatidiform Mole
Hydatidiform mole is a pregnancy
characterized by vesicular swelling of
placental villi (simple vesicular)
oComplete mole - only molar change
oPartial mole - part of the embryo is formed

4. • In this condition the trophoblast shows
marked proliferation and embryo dies at an
early stage.
• The chorionic villi undergo hydropic
degeneration and shows gross oedema.

5. Complete mole
• Mass of tissue is completely made up of
abnormal cells
• There is no fetus
• Arise from an empty ovum fertilized by a
sperm, which then duplicates its own
chromosomes
• Molar chromosomes- entirely paternal in
origin
• Karyotype: 46XX (90% cases); 46XY(10%)
• mitochondrial DNA is maternal

6. Partial mole
Mass may contain both abnormal cells and often a
fetus that has severe defects.
• Chorionic villi of varying size with focal hydatidiform
swelling
• Ovum fertilize with 2 sperms or 1 sperm which
dupilcates
Chromosomes are paternal and maternal, triploid
69,XXY
69,XXX or 69,XYY
• Identifiable fetal or embryonic tissues may present
• exhibits stigmata of triploidy: growth retardation,
multiple congenital malformations

8. Symptoms and Signs
• Vaginal Bleeding: most common symptom
in early pregnancy, they may even passed
vesicles
• Hyperemesis gravidarum and : associated
with elevated hCG levels
• Preeclampsia is observed in about 25%
patient

9. • Hyperthyroidism
Develops almost exclusively in patient with very high hCG levels
as hCG is thyroid stimulator
• Respiratory distress due to trophoblastic
embolization (rarely)
• Theca luteal ovarian cyst
Result from ovarian hyper stimulation by high serum hCG levels
,and undergo spontaneous regression after evacuation of the
mole.

10. On Examination,
When palpating uterine fundus
• Uterine size larger than the gestational age

11. Diagnosis
• Markedly elevated hCG levels-(these cyst
developed due to high hCG levels and undergo
spontaneous regression after evacuation of
the mole)

12. USS
• USS shoes the typical “snow storm”
appearance
• B/L theca –luteal cysts are usually presnent in
majority of patient

13. Treatment
When the diagnosis of hydatidiform mole is
established, the molar pregnancy should be
evacuated.
• Suction evacuation
No medical termination due to risk of embolisation

14. Suction evacuation
• Oxytocin drip (20 units in 500ml of saline)
should be started and once the uterine
contraction are established patient is taken to
OT
• Suction evacuation performed
• After that patient should be follow up with
regular serum beta hCG levels

15. • Patient should be seen weekly until serum
beta hCG level normal and
• Also should be examined for vaginal nodules ,
regression of size of uterus , and disapear of
theca luteal cyst.
• Thereafter patient is seen 2 weekly for
another 3 month and monthly for another 9
month

16. During evacuation anticipate heavy bleeding
• DT * 5-6 units
• IV access with wide bore cannulise
• Perform by an experienced surgeon

17. Patient advice to
• Use barrier method
• OCP should be avoid until serum beta hCG
levels become normal
• Progesterone preparation should be avoided
as they cause irregular bleeding
• IUD also is best avoid

18. • More than 80% moles are benign and
outcome after treatment is very good
/pregnancy should be avoid until 12 month
• 10-15% moles develop inti invasive moles.
This condition is also known as persistence
trophoblastic disease

19. Invasive mole
Definition
This term is applied to a molar pregnancy in which
molar villi grow into the myometrium or its blood
vessels, and may extend into the broad ligament
and metastasize to the lungs, the vagina or the
vulva.
• May cause to uterine perforation and
gestational bleeding

20. Placental site tumours
Very rare and can follow any type of pregnancy
Composed only trophoblast cells
They are syncytial cells- hCG are absent (level
very low)
Diagnosis – curettage
Histological examination

21. Gestational Choriocarcinoma
• Characterized by abnormal trophoblastic
hyperplasia and anaplasia , absence of chorionic
villi (2-3%)
• A malignant form of GTD which can develop from
i. hydatidiform mole
ii. Normal pregnancy
iii. following an miscarriage
iv. ectopic pregnancy.
Tissue invade the wall and other organ

22. • Following evacuation patient presenting with
Continued irregular bleeding (ex-following
miscarriage )
• Both ovaries enlarge with theca lutein cyst
formed as result of high level of chorionic
gonadotrophins from tumor cells.

23. Theca lutein cyst is a type of bilateral functional
ovarian cyst filled with clear, straw-colored fluid.
To be classified a functional cyst, the mass must
reach a diameter of at least three centimeters.

24. Metastatic
• Vagina is common site- it appears as
purplish nodules that resemble
haematomas
• Secondary spread to- lungs, liver, brain ,
and bone
• Lungs are common
( cannon ball lesions ) typically in
choriocarcinoma

25. Treatment
• After evacuation of vesicular mole patient has
to be followed up with serum beta hCG levels.
• If the level rising ,curettage of cavity is done
for histological confirmation
• Chemotherapy done with METHOTREXATE
and combination with ACTINOMYCIN D and
other agents

26. • Hysterectomy is not recommended routinely
but should be considered in resistant disease
and if there is sever hemorrhage