Molar pregnancies (MPs; hydatidiform moles) are chromosomally abnormal pregnancies that have the potential to become malignant.
Higher possibility of gestational trophoblastic disease (GTD) for women less than 20 years of age or over 35 years of age, and in those who have experienced GTD in a previous pregnancy.
Most common presenting symptom is vaginal bleeding.
Suction dilation and evacuation (D&E) or hysterectomy are the preferred treatments.
The risk of postmolar neoplasm is almost 20% for those with complete molar pregnancy.
Rate of cure for postmolar gestational trophoblastic neoplasia exceeds 95%, often with preservation of fertility.
Hydatidiform moles are chromosomally abnormal pregnancies that have the potential to become malignant (gestational trophoblastic neoplasia). Gestational trophoblastic disease includes tumors of fetal tissues, including hydatidiform moles, arising from placental trophoblasts. Syncytiotrophoblasts secrete human chorionic gonadotropin (hCG) and, therefore, this hormonal product is used as a tumor marker for the disease.
History and exam
Key diagnostic factors
- first trimester of pregnancy
- missed period
- vaginal bleeding
- unusually large uterus for gestational age
Other diagnostic factors
- headache and photophobia
- shortness of breath and respiratory distress
- severe nausea and emesis
- tachycardia, tremor, insomnia, and diarrhea
- pelvic pain
- uterine bleeding
- peripheral edema
- extremes of maternal age
- prior gestational trophoblastic disease (GTD)
- blood group A, B, AB
- tobacco use
- diminished dietary fat and carotene
1st investigations to order
- serum beta human chorionic gonadotropin (hCG)
- serum PT, PTT
- serum metabolic panel
- serum thyroid-stimulating hormone (TSH)
- blood type with antibody screen
- pelvic ultrasound
- histologic exam of placental tissue
singleton molar pregnancy: desiring fertility
singleton molar pregnancy: not desiring fertility
viable twin fetus: elective termination not desired
viable twin fetus: elective termination
following initial management: high risk of gestational trophoblastic neoplasia with completed follow up unlikely
- Spontaneous abortion
- Multiple gestation
- Pelvic tumor
- Ultrasound in pregnancy
- Diagnosis and treatment of gestational trophoblastic disease
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