hydatidiform (hydatid) mole (molar pregnancy)
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Pathology
- abnormal pregnancy, no embryo
- polycystic mass resulting from proliferation of the trophoblast with hydropic degeneration & avascularity of the chorionic villi
Genetics
- abnormal tissue generally results from expression of paternally-derived chromosomes & loss of maternal chromosomes
- associated with defects in NALP7 gene
Clinical manifestations
- vaginal bleeding
- lower abdominal cramping or pelvic cramping
Laboratory
- serum beta-hCG > levels during normal pregnancy raises suspicion of hydatidiform mole
- example of serum beta-hCG 14,000 mIU/mL at 5 weeks gestation (normal 217-7138)[3]
- serum beta-hCG > 100,000 IU/L indicates exuberant trophoblastic growth & raises suspicion of a molar pregnancy <standard of care>[2]
- CBC
- PT/PTT, INR
- Liver function tests
- Renal function tests
- Thyroid function tests
- serum inhibin A & serum activin A
- both 7-10-fold higher in molar pregnancies than normal pregnancies at the same gestational age
- the decline in levels after evacuation may prove helpful
Radiology
- ultrasound shows multiple anechoic masses (cluster of grapes appearance)
- normally gestational sac should be visible at 5 weeks gestation
- baseline chest X-ray
Complications
- transformation to choriocarcinoma
- metastastis to lungs
- thyroid storm (rare)
- trophoblastic embolization during surgery
Management
- general
- supportive care
- transfuse for anemia
- correct any coagulopathy
- treat hypertension
- surgery
- dilation and curettage is always necessary.
- prostaglandin or oxytocin induction is not recommended due to risk of bleeding & malignant sequelae
- intravenous oxytocin should be started after dilation of the cervix at the initiation of suctioning & continued postoperatively to reduce the likelihood of hemorrhage
- gynecologic oncology consult for chorocarcinoma