A molar pregnancy is an abnormal form of pregnancy where a non-viable, fertilized egg implants in the uterus and converts normal pregnancy processes into pathological ones. It results in a non-cancerous tumor that develops in the uterus instead of a viable pregnancy. There are two types - a complete molar pregnancy caused by a sperm fertilizing an egg without DNA, and a partial molar pregnancy with an abnormal embryo and some normal placental tissue. Molar pregnancies are diagnosed through physical exams, blood tests, ultrasound and tissue samples. They require early evacuation of the uterus to prevent risks like choriocarcinoma cancer, and patients need monitoring until human chorionic gonadotropin hormone levels fall.

1. Case # 1 Molar Pregnancy

2. Definition A molar pregnancy also known as hydatidiform mole is an abnormal form of pregnancy, wherein a non-viable, fertilized egg implants in the uterus, and thereby converts normal pregnancy processes into pathological ones. It’s a non cancerous tumor as that develops in the uterus. A molar pregnancy occurs when the placenta develops into an abnormal mass of cysts rather than becoming a viable pregnancy. Molar pregnancy is a type of gestational trophoblastic disease (GTD). It can be complete molar pregnancy or incomplete. In a complete molar pregnancy is caused by a single sperm combining with an egg which has lost its DNA, so there's no embryo or normal placental tissue. In a partial molar pregnancy, there's an abnormal embryo and possibly some normal placental tissue. The embryo begins to develop but is malformed and can't survive. A molar pregnancy can have serious complications, including a rare form of cancer like choriocarcinoma and a malignant tumor of trophoblast cells

3. Etiology It is understood. Potential risk factors may include defects in the egg, abnormalities within the uterus , or nutritional deficiencies. Women under 20 or over 40 years of age have a higher risk. Other risk factors include diets low in protein , folic acid , and carotene ..

4. Physiological process Physiological process : molar pregnancy occurs when the sperm duplicates itself because the egg is either lost or inactivated and lacking genetic information, so because of that there is no fetus, no placenta, no fluid and no amniotic membranes and the uterus is rather filled with the mole that resembles a bunch of grapes. Because there is no placenta in the uterus to receive the blood the women will experience bleeding into the uterine cavity or vaginal bleeding.

5. Diagnosis Diagnosis : Patient physical exam, enlarge uterus, hyperemesis, high blood pressure, amenorrhea, breast tender, bleeding, cramps, and weight lose. Lab: blood test detecting levels of HCG Ultrasound (sonogram) Histopathological exam.

6. Treatment When molar pregnancy is diagnosed requires early treatment. Careful monitoring after a molar pregnancy can help preserve the chance for future healthy pregnancies. Hydatidiform moles should be treated by evacuating the uterus by uterine suction or by surgical curettage as soon as possible after diagnosis, in order to avoid the risks of choriocarcinoma . Patients are usually fallow until HCG falls.

7. Prognosis 80% Molar pregnancy is usually benign with an diagnosis and early treatment 10-15% development as invasive molar 2-3% development as choriocarcinoma

8. Female Reproductive System Normal Female Reproductive System

9. Normal uterine anatomy

10. Molar Pregnancy The mole that resembles a bunch of grapes.

11. Histology Diagnosis Histology studies are important in the diagnosis of Molar Pregnancy

12. Pathology Diagnosis This is a real picture of a molar pregnancy

13. Imaging the Endometrium: Disease and Normal Variants #1 This image shows grapes tissue

14. Imaging the Endometrium: Disease and Normal Variants #2

15. Imaging the Endometrium: Disease and Normal Variants #3

16. References -Lancy C. Castro, MD, FACOG,Core Obstetrics and Gynecology clinical cases, Western University of Heath Sciences, Part I Obstetrics, Pomona, CA, 2010. www.pregnancy-calendars.net www.MayoClinic.com/ http://www.ncbi.nlm.nih.gov www.Wikipedia.org