Makindo Medical Notes

Related Subjects: |Introduction to Obstetrics and Gynaecology |Female Reproductive Anatomy and Physiology |Basic Concepts of Pregnancy |Health Issues In Pregnancy |Risk assessment In Pregnancy |Anaemia In Pregnancy |Hypertension In Pregnancy |Diabetes In Pregnancy |Epilepsy In Pregnancy |Hyperemesis In Pregnancy |Obesity In Pregnancy |Prescribing in Pregnancy |Multiple Pregnancy |Preterm Labout |Management of Labour and Complications |Assessment of the newborn

The term "hydatis" comes from Greek, meaning "watery cyst." It describes a type of gestational trophoblastic disease (GTD) that occurs when an abnormal fertilization event leads to the growth of atypical tissue within the uterus.

About

• A benign tumor of trophoblast cells containing 46 chromosomes, all of paternal origin.
• Complete Mole: Typically occurs when an empty egg is fertilized by a single sperm, which then duplicates its DNA.
• Partial Mole: Contains 69 chromosomes (two paternal and one maternal set) and presents no risk of choriocarcinoma.
• Women under 20 or over 40 years of age have a higher risk of developing hydatidiform moles.

This tissue is characterized by swollen, fluid-filled villi resembling grape-like clusters. Hydatidiform moles are classified into two types: complete and partial, based on the degree of abnormality and genetic composition.

Types of Hydatidiform Mole

• Complete Mole: Occurs when an egg with no genetic material is fertilized by a sperm, resulting in tissue that consists entirely of abnormal placental cells without any fetal tissue. Complete moles carry a higher risk of developing into invasive moles or choriocarcinoma (a type of cancer).
• Partial Mole: Occurs when an egg is fertilized by two sperm, creating an abnormal pregnancy with both abnormal placental tissue and some fetal tissue. The fetus is usually not viable, and partial moles are less likely to become malignant than complete moles.

Clinical Features

• Can cause bleeding in early to mid-pregnancy, often in the first trimester.
• Exaggerated pregnancy symptoms such as severe nausea and vomiting due to elevated hCG levels.
• Passage of grape-like cysts (swollen chorionic villi) vaginally.
• Metastasis to the lungs may cause symptoms like haemoptysis and pleurisy.
• Markedly elevated Beta hCG, which can mimic TSH and lead to hyperthyroid symptoms.
• Pre-eclampsia (high blood pressure and proteinuria) can occur before 20 weeks of gestation.

Investigations

• Ultrasound (USS): Primary diagnostic tool. Typically reveals a "snowstorm" pattern or the absence of a fetus for a complete mole, and an abnormal placenta with a malformed fetus for a partial mole. Approximately 1 in 30 cases develop choriocarcinoma.
• hCG Levels: Blood tests reveal significantly elevated hCG levels, far higher than expected for a normal pregnancy.
• Histopathological Examination: Examination of uterine contents post-evacuation confirms the diagnosis and determines if the mole is complete or partial.

Management

• Suction Curettage: Surgical removal of molar tissue from the uterus via suction curettage.
• Monitoring hCG Levels: hCG levels are monitored until they normalize to ensure all molar tissue has been removed and to detect any malignancy early.
• Chemotherapy: If hCG levels fail to return to normal or if there is evidence of persistent gestational trophoblastic disease, chemotherapy may be required.
• Hysterectomy: In women who do not wish to have more children, a hysterectomy may be considered to prevent recurrence.