Hydatidiform moles are abnormal placental growths that can be benign (complete and partial) or malignant (invasive). Complete moles exhibit diploid chromosomal composition and typically contain no fetal tissue, while partial moles may show some fetal development but are also lethal. Diagnosis involves elevated hCG levels and characteristic ultrasound findings, with management including evacuation and follow-up to monitor hCG levels.

1. Hydatidiform
(vesicular) Mole

2. Hydatidiform moles are excessively
edematous immature placentas. These
include the benign complete hydatidiform
mole and partial hydatidiform mole and the
malignant invasive mole.

3. • A complete mole has abnormal chorionic villi
that grossly appear as a mass of clear
vesicles. These vary in size and often hang
in clusters from thin pedicles.
• A partial molar pregnancy has focal and less
advanced hydatidiform changes and
contains some fetal tissue
• Invasive mole is deemed malignant due to its
marked penetration into and destruction of
the myometrium as well as its ability to
metastasize

4. HYDATIDIFORM MOLE
• Incidence more common among
asians,Hispanics and American Indians
• in india 1 in 400 pregnancies
• increased incidence in women at the
extremes of reproductive ages( adolescents
and women aged 36 to 40 years have a
twofold risk, but those older than 40 have an
almost tenfold risk)
• previous molar pregnancy-recurrence in 1-
2% cases

5. PATHOLOGY
• chromosomally abnormal fertilizations
• Complete moles- diploid chromosomal
composition (46,XX) and result from
androgenesis (both sets of chromosomes are
paternal in origin)
• Partial moles usually have a triploid karyotype
—69,XXX, 69,XXY—or 69,XYY. These are
each composed of two paternal haploid sets
of chromosomes and one maternal haploid
set

7. COMPLETE HYDATIDIFORM MOLE
• No evidence of existence of fetus
• Fetal blood vessels are not seen in the
villi
• There is hydropic degeneration,swelling of
the villous stroma and trophoblastic
proliferation
• Diploid and completely paternal in origin-
arise due to duplication of haploid sperm
following fertilisation of an empty ovum
• Marked increase in circulating hCG

9. PARTIAL HYDATIDIFORM MOLE
• There is focal trophoblastic proliferation
with cystic degeneration mixed with
areas of normal chorionic villi
• These triploid zygotes result in some
embryonic development, however, it
ultimately is a lethal fetal condition.
Fetuses that reach advanced ages
have severe growth restriction, multiple
congenital anomalies,or both.

13. SYMPTOMS
 Amennorrhea of varying duration
 Passage of vesicles per vaginum/bleeding
p/v.
 Hyperemisis is common due to high levels
of circulating hCG
 Respiratory symptoms in case of embolism

14. SIGNS
 Uterus is more than period of amenorrhea in
50% cases .In 35% cases ,it will correspond
to the gestational perod and in rest it may be
smaller.
 Fetal parts will not be felt,fetal heart sound
absent
 Doughy consistency of uterus
 Multiple Theca lutein cysts in about 50%.
 Early onset of preeclampsia
 Thyrotoxicosis

15. DIAGNOSIS
Elevated Bhcg values: more than usual
pregnancy values
*With more advanced moles, values in the
millions are not unusual. Importantly, these
high values can lead to erroneous false-
negative urine pregnancy test results because
of oversaturation of the test assay by
excessive β-hCG

16.  The ultrasound appearance is diagnostic
described as “snow strom appearance”
 It may show the presence of multiple theca
lutein cysts in the ovaries
 In a partial mole,ultrasound may show
foetus
 The most common misdiagnosis is
incomplete or missed abortion.
Occasionally, molar pregnancy may be
confused for a multifetal pregnancy or a
uterine leiomyoma with cystic degeneration

18. DIFFERENTIAL DIAGNOSIS
 Threatened abortion
 Multiple pregnancy
 Tumors complicating pregnancy

19. MANAGEMENT

21. Evacuation
Suction evacuation is done irrespective of
the size of uterus.
Compatible blood has to be arranged
As evacuation is begun, oxytocin is
infused to limit bleeding.
All products of conception should undergo
histopathological examination.
Anti-D to be given to an Rh negative
mother.

22. • Hysterectomy with ovarian preservation
may be preferable for women who have
completed childbearing. (>40 years - 1/3rd
will develop GTN and hysterectomy
markedly reduces this risk.
• Chest radiograph following the procedure

23. Follow-up
• The initial β-hCG level is obtained within 48 hours
after evacuation. This serves as the baseline,
which is compared with β-hCG quantification done
thereafter every 1 to 2 weeks until levels
progressively decline to become undetectable.
• The median time for such resolution is 7 weeks for
partial moles and 9 weeks for complete moles.
Once β-hCG is undetectable, this is confirmed with
monthly determinations for another 6 months. After
this, surveillance is discontinued and pregnancy
allowed.

24. Risk of GTN
• About 80% of complete moles
regress,while 20% may progress to GTN.
• Of these,15% may be non-metastatic &
5% metastatic.
• In case of partial moles, the risk is much
less(5-4%) & is usually nonmetastatic.

25. The main risk factors of postmolar GTN are;
a) Advanced maternal age.
b) Preevacuation high hCG>100000mIU/ml.
c) Uterus large for gestational age.
d) theca lutein cysts >6cm
e) slow decline in Bhcg levels

26. Contraception
Barrier contraception is safest until serum
beta hCG levels become normal.
 combination hormonal contraception or
injectable medroxyprogesterone acetate
can be used
An IUD shouldn’t be used until serum beta
hCG levels become normal (risk of
perforation in invasive mole)

27. Thank you