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MRS.ELIZEBETH RANI ,
READER,
VHS- MACCON
 It is gestational trophoblastic disease in which abnormal
proliferation & degeneration of the trophoblast villi occur.
The cells degenerate &become filled with fluid giving grape
sized vesicles.
Definition
It is an abnormal condition of the placenta where there
are partly degenerative & partly proliferative changes in
the young chorionic villi . These results in the formation of
clusters of small cysts of varying sizes. Because of its
superficial resemblance to hydatid cyst, it is named as
hydatidform mole.
TYPES
 a partial mole occurs when
an egg is fertilized by two
sperm or by one sperm which
reduplicates itself yielding
the genotypes of 69,XXY
(triploid) or 92,XXXY
(quadraploid).[2] Complete
hydatidiform moles have a
higher risk of developing into
choriocarcinoma — a
malignant tumor of
trophoblast cells — than do
partial moles.
 A complete mole is
caused by a single
sperm combining with
an egg which has lost its
DNA (the sperm then
reduplicates forming a
"complete" 46
chromosome set) [2] The
genotype is typically
46,XX (diploid) due to
subsequent mitosis of
the fertilizing sperm,
but can also be 46,XY
(diploid).[
PARTIAL MOLE COMPLETE MOLE
Formation of clusters of small cyst of varying
degree
Collectively take appearance of a bunch of
grasp
Villa filled
with fluid
Villi cotinue
to multiply
Uterine
enlargement
Young chorionic villiYoung chorionic villi
Partly degenerate
changes
Partly proliferate
changes
In placenta (abnormal condition )
blood not reaches to fetus
no oxygen &nutrient to fetus
fetus die &become absorbed
No intervillous blood
circulation
choriodecidual spaces
obliterated
maternal blood can not
circulate
creamy white
appearance
Pathophysiology
 Not definitely known .
FOLLOWING FACTORS & HYPOTHESIS
HAVE BEEN FORWARDED :
 Highest in teenage pregnancies &
women over 35 years.
 Faulty nutrition like inadequate
intake of protein animal &
carotene.
 Disturbed maternal immune
mechanism
 Cytogenetic abnormality.
 Higher ratio of paternal.
 History of prior hydatidiform
mole.
 Age & parity.
Symptoms :
 Vaginal bleeding
 Lower abdominal pain
 Constitutional symptoms
a) Patient becomes sick without apparent reason
b) Vomitting of pregnancy
c) Breathlessness
d) Thyrotoxic features
 Expulsion of grape like vesicles
per vaginum
 History of quickening is abscent.
 Signs :
 Patient looks more ill
 Pallor
 Features of pre-eclampsia
Per abdomen :
 Uterine size more than amenorrhea
 Feel of the uterus is firm elastic
 Fetal parts are not felt
 Absence of fetal heart sound
 Vaginal examination :
 Internal ballotment can not be
elicited
 Unilateral / bilateral enlargement of
the ovary.
 Finding of vesicles
 Full blood count ,ABO & Rh grouping
 Hepatic ,Renal & Thyroid function test
 Sonograpy
 Quantitative estimation of chorionic
gonadotrophin
 Straight X-ray abdomen
 CT & MRI
 Hemorrhage & shock
 Sepsis
 Perforation of the
uterus
 Pre-eclampsia with
convulsion
 Acute pulmonary
insufficiency
 Coagulation failure
 Development of
choriocarcinoma
Immediate Late
 To the OR for D&C and pathology revealed a
complete hydatidiform mole.
Evacuating the uterus by uterine
suction or by surgical curettage as
soon as possible after diagnosis.
Hydatidiform mole/molar pregnancy (complete or
incomplete) malignant
ACCELERATE
EVACUATION
ACCELERATE
EVACUATION
UTERUS INSERT
IN PROCESS OF
EXPULSION
IN PROCESS OF
EXPULSION
GENTLE CURRETAGE
EVACUATION
GENTLE CURRETAGE
FOLLOWING
EVACUATION
PATIENT YOUNG
DESIRES OF CHILD
PATIENT YOUNG
DESIRES OF CHILD
VAGINAL
HYSTERECTOMY
AGE > 35
H.MOLE
AGE > 35
FAMILY COMPLETED
PERFORATING
H.MOLE
EVACUATION
ABDOMINAL
HYSTERECTOMY
ABDOMINAL
HYSTERECTOMY
CERVIX
UNFAVORABLE
CERVIX
UNFAVORABLE
SLOW DILATATION
OF THE CERVIX
SLOW DILATATION
OF THE CERVIX
OXYTOCIN DRIPOXYTOCIN DRIP
CERVIX FAVORABLE
SUCTION EVACUATION
CERVIX FAVORABLE
SUCTION EVACUATION + ESCALATING OXYTOCINSUCTION EVACUATION + ESCALATING OXYTOCIN
CURETTAGE INCURETTAGE IN
SELECTED CASES
I.V.infusion
Blood transfusion
Suction evacuation
+
oxytocin drip
To correct anemia blood transfusion
To keep blood during evacuation
Follow up as a routine ( at least for 6 months )
Monitor maternal serum / urine
Follow up as a routine ( at least for 6 months )
Monitor maternal serum / urine hcg
HCG level plateaus
(OR ) re-elevation
HCG level plateaus
(OR ) re-elevation
ray , CT /MRI brain
Evaluate for persistent trophoblastic
neoplasia ( chest X-ray , CT /MRI brain
, chest, pelvis, serum HCG
Exclude new pregnancyExclude new pregnancy
Monthly follow up for
atleast 6 months
Monthly follow up for
atleast 6 months
HCG levels return to
normal (4 to 6)
HCG levels return to
normal (4 to 6)
Prophylactic cytotoxic therapy
(controversial)
Hydatidiform mole on CT, sagittal
view Hydatidiform mole on CT, axial view
Histopathogic image of hydatidiform
mole (complete type). H & E stain.
Hydatidiform mole
PROGNOSIS
 More than 80% of hydatidiform moles are benign. The outcome
after treatment is usually excellent. Close follow-up is essential.
Highly effective means of contraception are recommended to
avoid pregnancy for at least 6 to 12 months.
 In 10 to 15% of cases, hydatidiform moles may develop into
invasive moles. This condition is named persistent trophoblastic
disease (PTD). The moles may intrude so far into the uterine wall
that hemorrhage or other complications develop. It is for this
reason that a post-operative full abdominal and chest x-ray will
often be requested.
 In 2 to 3% of cases, hydatidiform moles may develop into
choriocarcinoma, which is a malignant, rapidly-growing, and
metastatic (spreading) form of cancer. Despite these factors
which normally indicate a poor prognosis, the rate of cure after
treatment with chemotherapy is high.
 Over 90% of women with malignant, non-spreading cancer are
able to survive and retain their ability to conceive and bear
children. In those with metastatic (spreading) cancer, remission
remains at 75 to 85%, although their childbearing ability is
usually lost.
REFERENCE
 Bobak, I.M., & Leonard, D. (1995). Text Book Of Maternity & Gynecologic
Care :The Nurse & The Family (4th ed.). Mosby Publication.
 Diane., Fraser., & Margret. (2003). Text Book for Midwives (14th ed.).
Elsevier Publishers.
 Dutta, D.c., & Hiralal Konar. (2013). Text Book of Obstetrics (7th ed.). Jaypee
Brothers Medical Publishers.
 Elizabeth, M (2014). Midwifery for Nurses (2nd ed.). Sathish Kumar Jain
Publishers.
 Jacob, A. (2008). A Comprehensive textbook of Midwifery & Gynecological
Nursing (4th ed.). Newyork: Jaypee Brothers Medical Publishers.
 Kumari Neelam., Sharma Shivani., & Gupta Preethi. (2010). A Text Book of
Midwifery and Gynecological Nursing.
 Ladewig, L. Maternal & Newborn Nursing (3rd ed.). Cumming Publication.
 Nurse Midwifery Helen Varney (2nd ed.).
 Parulekar, V. S. Textbook for Midwives. (2nd ed.). Mumbai: Vora Medical
Publications.
 Raman, A. V. (2014). Maternity nursing (1st ed.). Wolters kluwer publishers.
 Richa S. Snapshort In Obstetrical & Gynaecology. Jaypee Brother’s Medical
Publisher.
Hydatid form mole

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Hydatid form mole

  • 2.  It is gestational trophoblastic disease in which abnormal proliferation & degeneration of the trophoblast villi occur. The cells degenerate &become filled with fluid giving grape sized vesicles. Definition It is an abnormal condition of the placenta where there are partly degenerative & partly proliferative changes in the young chorionic villi . These results in the formation of clusters of small cysts of varying sizes. Because of its superficial resemblance to hydatid cyst, it is named as hydatidform mole.
  • 3. TYPES  a partial mole occurs when an egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid) or 92,XXXY (quadraploid).[2] Complete hydatidiform moles have a higher risk of developing into choriocarcinoma — a malignant tumor of trophoblast cells — than do partial moles.  A complete mole is caused by a single sperm combining with an egg which has lost its DNA (the sperm then reduplicates forming a "complete" 46 chromosome set) [2] The genotype is typically 46,XX (diploid) due to subsequent mitosis of the fertilizing sperm, but can also be 46,XY (diploid).[ PARTIAL MOLE COMPLETE MOLE
  • 4. Formation of clusters of small cyst of varying degree Collectively take appearance of a bunch of grasp Villa filled with fluid Villi cotinue to multiply Uterine enlargement Young chorionic villiYoung chorionic villi Partly degenerate changes Partly proliferate changes In placenta (abnormal condition ) blood not reaches to fetus no oxygen &nutrient to fetus fetus die &become absorbed No intervillous blood circulation choriodecidual spaces obliterated maternal blood can not circulate creamy white appearance Pathophysiology
  • 5.  Not definitely known . FOLLOWING FACTORS & HYPOTHESIS HAVE BEEN FORWARDED :  Highest in teenage pregnancies & women over 35 years.  Faulty nutrition like inadequate intake of protein animal & carotene.  Disturbed maternal immune mechanism  Cytogenetic abnormality.  Higher ratio of paternal.  History of prior hydatidiform mole.
  • 6.  Age & parity. Symptoms :  Vaginal bleeding  Lower abdominal pain  Constitutional symptoms a) Patient becomes sick without apparent reason b) Vomitting of pregnancy c) Breathlessness d) Thyrotoxic features  Expulsion of grape like vesicles per vaginum  History of quickening is abscent.  Signs :  Patient looks more ill  Pallor  Features of pre-eclampsia Per abdomen :  Uterine size more than amenorrhea  Feel of the uterus is firm elastic  Fetal parts are not felt  Absence of fetal heart sound  Vaginal examination :  Internal ballotment can not be elicited  Unilateral / bilateral enlargement of the ovary.  Finding of vesicles
  • 7.  Full blood count ,ABO & Rh grouping  Hepatic ,Renal & Thyroid function test  Sonograpy  Quantitative estimation of chorionic gonadotrophin  Straight X-ray abdomen  CT & MRI
  • 8.  Hemorrhage & shock  Sepsis  Perforation of the uterus  Pre-eclampsia with convulsion  Acute pulmonary insufficiency  Coagulation failure  Development of choriocarcinoma Immediate Late
  • 9.  To the OR for D&C and pathology revealed a complete hydatidiform mole.
  • 10. Evacuating the uterus by uterine suction or by surgical curettage as soon as possible after diagnosis. Hydatidiform mole/molar pregnancy (complete or incomplete) malignant
  • 11. ACCELERATE EVACUATION ACCELERATE EVACUATION UTERUS INSERT IN PROCESS OF EXPULSION IN PROCESS OF EXPULSION GENTLE CURRETAGE EVACUATION GENTLE CURRETAGE FOLLOWING EVACUATION PATIENT YOUNG DESIRES OF CHILD PATIENT YOUNG DESIRES OF CHILD VAGINAL HYSTERECTOMY AGE > 35 H.MOLE AGE > 35 FAMILY COMPLETED PERFORATING H.MOLE EVACUATION ABDOMINAL HYSTERECTOMY ABDOMINAL HYSTERECTOMY CERVIX UNFAVORABLE CERVIX UNFAVORABLE SLOW DILATATION OF THE CERVIX SLOW DILATATION OF THE CERVIX OXYTOCIN DRIPOXYTOCIN DRIP CERVIX FAVORABLE SUCTION EVACUATION CERVIX FAVORABLE SUCTION EVACUATION + ESCALATING OXYTOCINSUCTION EVACUATION + ESCALATING OXYTOCIN CURETTAGE INCURETTAGE IN SELECTED CASES I.V.infusion Blood transfusion Suction evacuation + oxytocin drip To correct anemia blood transfusion To keep blood during evacuation
  • 12. Follow up as a routine ( at least for 6 months ) Monitor maternal serum / urine Follow up as a routine ( at least for 6 months ) Monitor maternal serum / urine hcg HCG level plateaus (OR ) re-elevation HCG level plateaus (OR ) re-elevation ray , CT /MRI brain Evaluate for persistent trophoblastic neoplasia ( chest X-ray , CT /MRI brain , chest, pelvis, serum HCG Exclude new pregnancyExclude new pregnancy Monthly follow up for atleast 6 months Monthly follow up for atleast 6 months HCG levels return to normal (4 to 6) HCG levels return to normal (4 to 6) Prophylactic cytotoxic therapy (controversial)
  • 13. Hydatidiform mole on CT, sagittal view Hydatidiform mole on CT, axial view Histopathogic image of hydatidiform mole (complete type). H & E stain. Hydatidiform mole
  • 14. PROGNOSIS  More than 80% of hydatidiform moles are benign. The outcome after treatment is usually excellent. Close follow-up is essential. Highly effective means of contraception are recommended to avoid pregnancy for at least 6 to 12 months.  In 10 to 15% of cases, hydatidiform moles may develop into invasive moles. This condition is named persistent trophoblastic disease (PTD). The moles may intrude so far into the uterine wall that hemorrhage or other complications develop. It is for this reason that a post-operative full abdominal and chest x-ray will often be requested.  In 2 to 3% of cases, hydatidiform moles may develop into choriocarcinoma, which is a malignant, rapidly-growing, and metastatic (spreading) form of cancer. Despite these factors which normally indicate a poor prognosis, the rate of cure after treatment with chemotherapy is high.  Over 90% of women with malignant, non-spreading cancer are able to survive and retain their ability to conceive and bear children. In those with metastatic (spreading) cancer, remission remains at 75 to 85%, although their childbearing ability is usually lost.
  • 15. REFERENCE  Bobak, I.M., & Leonard, D. (1995). Text Book Of Maternity & Gynecologic Care :The Nurse & The Family (4th ed.). Mosby Publication.  Diane., Fraser., & Margret. (2003). Text Book for Midwives (14th ed.). Elsevier Publishers.  Dutta, D.c., & Hiralal Konar. (2013). Text Book of Obstetrics (7th ed.). Jaypee Brothers Medical Publishers.  Elizabeth, M (2014). Midwifery for Nurses (2nd ed.). Sathish Kumar Jain Publishers.  Jacob, A. (2008). A Comprehensive textbook of Midwifery & Gynecological Nursing (4th ed.). Newyork: Jaypee Brothers Medical Publishers.  Kumari Neelam., Sharma Shivani., & Gupta Preethi. (2010). A Text Book of Midwifery and Gynecological Nursing.  Ladewig, L. Maternal & Newborn Nursing (3rd ed.). Cumming Publication.  Nurse Midwifery Helen Varney (2nd ed.).  Parulekar, V. S. Textbook for Midwives. (2nd ed.). Mumbai: Vora Medical Publications.  Raman, A. V. (2014). Maternity nursing (1st ed.). Wolters kluwer publishers.  Richa S. Snapshort In Obstetrical & Gynaecology. Jaypee Brother’s Medical Publisher.