Hydatidiform Mole ( Vesicular ) Management
Hydatidiform Mole ( Vesicular )
Hydatidiform Mole :
It is a developmental anomaly of the placenta and the trophoplast in which the fertilized ovum deteriorates and the chorionic villi convert into a mass of clear grape-like vesicles.
It is one of the most common lesions anteceding choriocarcinoma, a malignant tumor of the trophoblast with a tendency toward rapid and widespread metastasis.
The cause is unknown, but factors contributed are:
- Maternal age: below 20 years and above 45 years.
- Genetic factors.
- High parity and malnutrition.
Vesicular mole is classified into complete and partial moles according to the presence or absence of a fetus or embryo and its location or dissemination.
1- Bleeding: the most common sign and vary from spotting to profuse, continuous or intermittent red or brownish bloody discharge, about the 12th week of gestation, may also pass villi.
2- Enlargement of the uterus is out of proportion to what it normally is at a specific time in pregnancy.
3- Signs of Preeclampsia or Eclampsia earlier than 20 weeks of gestation.
4- Hyperemesis Gravidarum experienced by 30 % of women with this condition.
5- Pallor and dyspnea anemia.
6- hCG titer is markedly increased beyond the 90th day of gestation when normally expected to drop.
7- Anxiety and tremors thyroid dysfunction due to high hCG.
8- Uterine discomfort due to overstretching.
9- Absent fetal heart tone.
10- Absent fetal parts ( except in partial mole ) found on ultrasound Or X-ray.
- Ultrasound is a diagnostic method of choice.
- A patient often presents with vaginal bleeding, uterine enlargement in absence of fetal heart tone.
- CBC: Hb, HCT and RBCs are decreased.
- Blood chemistries: renal, liver and thyroid function test.
- Chest x-ray.
- hCG titers are elevated up to 1 to 2 million IU in 24 hours.
1- Suction curettage has low complications rate with uterine size < 16 weeks.
Excessive uterine enlargement may be predisposed to pulmonary complications as preeclampsia and fluid overload.
2- Primary Hysterectomy:
- Patients who have completed childbearing and desire sterilization are good candidates.
- Reduces malignant sequelae from 20 % to 5 %.
3- Prophylactic chemotherapy:
- May reduce malignant sequelae in high-risk patients.
- Not routinely recommended in cases of the uncomplicated mole.
4- Blood transfusion: to correct anemia and replace blood loss.
follow up supervision at least for 1 year includes the following :
1- Hcg measurement as:
Once weekly until titers are negative for 3 consecutive weeks, then:
Once monthly for 6 months, then every 2 month for 6 months and every 6 months.
2- Chest x-ray to and detect metastases are done every month.
3- start contraceptive is the best choice.