Hydatidiform Mole ( Vesicular ) Management

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Hydatidiform Mole

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.

Etiology:


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.

Clinical manifestation:


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.

Diagnostic evaluation:

  • 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.

Management:


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:

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.

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