USEFUL TO UG AND PG NURSING ASPIRANTS

1. BY JASMI MANU
ASSO.PROFESSOR
DEPRTMENT OF OBG
NURSING
RCN
HYDATIDI
FORM MOLE

2. Definition vesicular mole
• It is an abnormal condition of the placenta where
there are partly degenerative and partly proliferative
changes in the young chorionic villi.
These result in the formation of clusters
of small cysts of varying size.

3. Types
• There are 2 types of hydatidiform
mole
1. Complete mole
2. Partial mole or incomplete mole

4. Incidence
• It is common in oriental countries Philippines,
china, Indonesia, India, central and Latin
America and Africa.
• The highest incidence is in Philippines being 1
in 80 pregnancies and lowest in European
countries and USA being about 1 in 2000.
• Incidence in India is about 1 in 400.

5. Etiology
• The cause is not exactly known, but appears to be
related to the ovular defect.
• High in teenage pregnancy and women over 35 yrs
of age.
• Prevalence vary with race.
• Faulty nutrition
• Disturbed maternal immune mechanism as rise in
IgG level and presence of ABO antibody.
• Cytogenic abnormalities.
• The higher the ratio of paternal and maternal
chromosomes.
• Previous history of hydatidiform mole.

6. •Pathology

7. Pathology
• Naked eye appearance
• Microscopic appearance
• Ovarian changes

8. Clinical features

9. • Investigations
1. CBC, ABO and Rh grouping
2. Hepatic, renal and thyroid function test.
3. Sonography of uterus, liver, kidney and spleen.
4. hCG estimation
5. Straight X-ray of abdomen
6. CT scan and MRI

10. Sonography

11. • Differential diagnosis

12. Complications
• Immediate
• Late

13. • Risk of hemorrhage and sepsis is diminished due to
early diagnosis and treatment.
• About 15-20% of complete moles persists to GTN
• About 5% develop metabolic disorders.
• 1-4% of risk of reoccurrence of molar pregnancy.
The improve prognosis is due to
1. Recognition of high risk factors.
2. Careful follow-up and with BhCG
3. Use of cytotoxic drugs at right time and on right cases
Prognosis

14. Management
• The principles of management
1. Supportive therapy to restore the blood loss
and to prevent infections..
2. To evacuate the uterus as soon as the
diagnosis is made.
3. Regular follow up for early detection of
persistent trophoblastic disease.

15. The patients are grouped into 2 groups
• Group A: The mole is in the process of
expulsion.
• Group B: The uterus is inert.

16. Supportive therapy
• Group A:
1. The patient present with varying amount
of bleeding.
2. To start a RL solution.
3. Arrange for blood transfusion.
• Group B: blood should be kept ready
prior to elective evacuation of the uterus.

17. Definite management
• Group A
Simultaneous with supportive therapy
500 ml RL IV infusion and oxytocin (10-20 units) to
enhance expulsion
• suction and evacuation.
1. Negative pressure up to 200-250mm Hg under GA and
diazepam
2. Digital exploration under diazepam
3. After evacuation methargin 0.2 mg is given I/M

18. • Group B- evacuation of the uterus is done as
soon as diagnosis is made.
1. vaginal evacuation
a. Cervix is favorable
 The preferred method is suction evacuation
1. Oxytocin may be started at risk of bleeding
2. Can be done under GA and diazepam sedation
3. alternatively conventional dilatation of cervix is
done after evacuation. During procedure use pulse
oximetery.

19. b. cervix is tubular or closed
 laminaria tent for suction and evacuation.
 Hysterotomy –It’s a rare procedure
 Hysterectomy
c. Curettage after vaginal evacuation(send
material for histopathological examination)
d. Prophylactic chemotherapy When
1. hCG level fails to come normal in 4-6 week
2. Evidence of metastasis
3. Where follow up facilities are not avilable
c. Follow up
d. Contraceptive advices

20. Unfavorable manifestations
• Persistent ill health.
• Abnormal vaginal bleed and continuing
amenorrhea.
• Appearance of respiratory symptoms
• Sub involution
• Secondary metastasis in the vagina.
• hCG titer remains elavated.

21. Partial or incomplete mole
In partial hydatidiform mole the
affection of the chorionic villi is focal.
There is a fetus or at least an amniotic
sac.

22. •Summary

24. Thank you