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Hydatidiform mole
🌱 The term "hydatis" comes from Greek, meaning "watery cyst." A hydatidiform mole is a type of gestational trophoblastic disease (GTD) caused by abnormal fertilisation, leading to atypical trophoblast proliferation inside the uterus.
📖 About
- Benign trophoblastic tumour with abnormal genetic origin.
- Complete Mole: Empty ovum + single sperm (that duplicates) → 46 paternal chromosomes → ⛔ no fetal tissue.
- Partial Mole: Normal egg + 2 sperm → 69 chromosomes (triploid) → abnormal placenta + some fetal tissue.
- Risk is higher in women <20 or >40 years old.
🍇 Characterised by swollen, fluid-filled villi resembling grape clusters.
🧬 Types
- Complete Mole: No fetal tissue, high malignant potential → ↑ risk of choriocarcinoma.
- Partial Mole: Abnormal placenta + non-viable fetus, usually benign course.
🩺 Clinical Features
- 🩸 Vaginal bleeding in 1st–2nd trimester.
- 🤢 Severe nausea/vomiting (hyperemesis gravidarum due to very high hCG).
- 🍇 Passage of grape-like vesicles per vaginam.
- 🦋 Hyperthyroid symptoms (hCG cross-reacts with TSH receptor).
- ⚡ Pre-eclampsia <20 weeks = think molar pregnancy until proven otherwise.
- 🌬️ Metastatic disease (lung: haemoptysis, pleuritic pain).
🔎 Investigations
- 📈 hCG: Markedly elevated, often >100,000 IU/L.
- 🖥️ Ultrasound: "Snowstorm" appearance (complete) or abnormal placenta ± malformed fetus (partial).
- 🧪 Histology: Confirms diagnosis post-evacuation.
🛠️ Management
- 🧹 Suction Curettage: First-line removal of molar tissue.
- 📉 Serial hCG monitoring: Weekly until normal, then monthly for 6–12 months.
- 💊 Chemotherapy: For persistent GTD or if hCG plateaus/rises.
- ⚔️ Hysterectomy: May be offered if fertility not desired.
- ⛔ Advise to avoid pregnancy until hCG surveillance complete.
💡 Clinical Pearl:
Any woman with pre-eclampsia <20 weeks OR abnormally high hCG should raise suspicion of molar pregnancy.
📚 Case Example
👩 A 19-year-old presents at 12 weeks with vaginal bleeding 🩸 and severe nausea 🤢. Uterus feels "large for dates." hCG is >150,000 IU/L. USS shows a snowstorm pattern with no fetus. ✅ Diagnosis: Complete molar pregnancy. 🛠️ Management: Suction curettage, followed by serial hCG monitoring.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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