The changing clinical presentation of molar pregnancy. Mola hidatiforme. OBJECTIVE: to determine whether the clinical presentation of hydatidiform mole has changed in the recent years when compared with historic controls The clinical signals and symptoms analyzed were: age distribution, number of pregnancies, vaginal bleeding, hyperemesis, edema, hypertension, large uterus for gestation date and theca lutein cysts of the ovaries. As to the number of pregnancies, there was no statistical difference only in those patients who were in their third or fourth pregnancies. Arterial hypertension was the only symptom that occurred with similar frequency in both groups.
|Published (Last):||25 April 2013|
|PDF File Size:||1.40 Mb|
|ePub File Size:||5.87 Mb|
|Price:||Free* [*Free Regsitration Required]|
Molar pregnancy is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus and will fail to come to term. A molar pregnancy is a gestational trophoblastic disease  which grows into a mass in the uterus that has swollen chorionic villi.
These villi grow in clusters that resemble grapes. The products of conception may or may not contain fetal tissue. It is characterized by the presence of a hydatidiform mole or hydatid mole, mola hydatidosa. In the first case, the sperm then reduplicates, forming a "complete" 46 chromosome set. In contrast, a partial mole occurs when a normal egg is fertilized by one or two sperm which then reduplicates itself, yielding the genotypes of 69,XXY triploid or 92,XXXY tetraploid.
Molar pregnancies are a relatively common complication of pregnancy, making up 1 in 1, pregnancies in the US, with much higher rates in Asia e.
Molar pregnancies usually present with painless vaginal bleeding in the fourth to fifth months of pregnancy. There may also be more vomiting than would be expected hyperemesis.
Sometimes there is an increase in blood pressure along with protein in the urine. Blood tests will show very high levels of human chorionic gonadotropin hCG.
The cause of this condition is not completely understood. Potential risk factors may include defects in the egg, abnormalities within the uterus , or nutritional deficiencies. Women under 20 or over 40 years of age have a higher risk.
Other risk factors include diets low in protein , folic acid , and carotene. This leads to overgrowth of the syncytiotrophoblast whereas dual egg-patterned methylation leads to a devotion of resources to the embryo, with an underdeveloped syncytiotrophoblast. This is considered to be the result of evolutionary competition , with male genes driving for high investment into the fetus versus female genes driving for resource restriction to maximise the number of children. The vesicles arise by distention of the chorionic villi by fluid.
When inspected under the microscope, hyperplasia of the trophoblastic tissue is noted. If left untreated, a hydatidiform mole will almost always end as a spontaneous abortion miscarriage. Based on morphology , hydatidiform moles can be divided into two types: in complete moles , all the chorionic villi are vesicular, and no sign of embryonic or fetal development is present. In rare cases a hydatidiform mole co-exists in the uterus with a normal, viable fetus.
These cases are due to twinning. The uterus contains the products of two conceptions: one with an abnormal placenta and no viable fetus the mole , and one with a normal placenta and a viable fetus. Under careful surveillance it is often possible for the woman to give birth to the normal child and to be cured of the mole. In most complete moles, all nuclear genes are inherited from the father only androgenesis.
In both cases, the moles are diploid i. In all these cases, the mitochondrial genes are inherited from the mother, as usual. Most partial moles are triploid three chromosome sets. The nucleus contains one maternal set of genes and two paternal sets. The mechanism is usually the reduplication of the paternal haploid set from a single sperm, but may also be the consequence of dispermic two sperm fertilization of the egg.
In rare cases, hydatidiform moles are tetraploid four chromosome sets or have other chromosome abnormalities. A small percentage of hydatidiform moles have biparental diploid genomes, as in normal living persons; they have two sets of chromosomes, one inherited from each biological parent.
Some of these moles occur in women who carry mutations in the gene NLRP7 , predisposing them towards molar pregnancy. These rare variants of hydatidiform mole may be complete or partial.
The diagnosis is strongly suggested by ultrasound sonogram , but definitive diagnosis requires histopathological examination. On ultrasound, the mole resembles a bunch of grapes "cluster of grapes" or "honeycombed uterus" or "snow-storm".
Sometimes symptoms of hyperthyroidism are seen, due to the extremely high levels of hCG, which can mimic the effects of thyroid-stimulating hormone. Hydatidiform moles should be treated by evacuating the uterus by uterine suction or by surgical curettage as soon as possible after diagnosis, in order to avoid the risks of choriocarcinoma. Invasive or metastatic moles cancer may require chemotherapy and often respond well to methotrexate.
Patients are advised not to conceive for half a year after hCG levels have normalized. Management is more complicated when the mole occurs together with one or more normal fetuses. In some women, the growth can develop into gestational trophoblastic neoplasia.
For women who have complete hydatidiform mole and are at high risk of this progression, evidence suggests giving prophylactic chemotherapy known as P-chem may reduce the risk of this happening. The uterine curettage is generally done under the effect of anesthesia, preferably spinal anesthesia in hemodynamically stable patients. The advantages of spinal anesthesia over general anesthesia include ease of technique, favorable effects on the pulmonary system, safety in patients with hyperthyroidism and non- tocolytic pharmacological properties.
Additionally, by maintaining patient's consciousness one can diagnose the complications like uterine perforation, cardiopulmonary distress and thyroid storm at an earlier stage than when the patient is sedated or is under general anesthesia. The outcome after treatment is usually excellent. Close follow-up is essential to ensure that treatment has been successful.
Women who have had a prior partial or complete mole, have a slightly increased risk of a second hydatidiform mole in a subsequent pregnancy, meaning a future pregnancy will require an earlier ultrasound scan.
This condition is named persistent trophoblastic disease PTD. The moles may intrude so far into the uterine wall that hemorrhage or other complications develop.
It is for this reason that a post-operative full abdominal and chest x-ray will often be requested. Despite these factors which normally indicate a poor prognosis, the rate of cure after treatment with chemotherapy is high. Hydatidiform moles are a common complication of pregnancy, occurring once in every 1, pregnancies in the US, with much higher rates in Asia e. From Wikipedia, the free encyclopedia. Abnormal form of pregnancy human disorder.
American Cancer Society. Merriam Webster. Retrieved May 7, Robbins and Cotran pathologic basis of disease 7th ed. Louis, Mo: Elsevier Saunders. Pathologic Basis of Disease 8th ed. Saunders Elsevier. McGraw-Hill Medical. Pediatric Research. June Gynaecology by Ten Teachers 18th ed. Hodder Arnold. American Journal of Obstetrics and Gynecology. Human Genetics. Clinical Genetics. September The Cochrane Database of Systematic Reviews. Indian Journal of Anaesthesia. Journal of Prenatal Medicine.
ICD - 10 : O01 , D Pathology of pregnancy , childbirth and the puerperium O , — Acute fatty liver of pregnancy Gestational diabetes Hepatitis E Hyperemesis gravidarum Intrahepatic cholestasis of pregnancy. Gestational pemphigoid Impetigo herpetiformis Intrahepatic cholestasis of pregnancy Linea nigra Prurigo gestationis Pruritic folliculitis of pregnancy Pruritic urticarial papules and plaques of pregnancy PUPPP Striae gravidarum. Chorea gravidarum. Gestational thrombocytopenia Pregnancy-induced hypercoagulability.
Amniotic fluid embolism Cephalopelvic disproportion Dystocia Shoulder dystocia Fetal distress Locked twins Obstetrical bleeding Postpartum Pain management during childbirth placenta Placenta accreta Preterm birth Postmature birth Umbilical cord prolapse Uterine inversion Uterine rupture Vasa praevia.
Breastfeeding difficulties Low milk supply Cracked nipples Breast engorgement Childbirth-related posttraumatic stress disorder Diastasis symphysis pubis Postpartum bleeding Peripartum cardiomyopathy Postpartum depression Postpartum psychosis Postpartum thyroiditis Puerperal fever Puerperal mastitis. Concomitant conditions Diabetes mellitus Systemic lupus erythematosus Thyroid disorders Maternal death Sexual activity during pregnancy.
Germinoma Seminoma Dysgerminoma. Authority control NDL : Categories : Germ cell neoplasia Pregnancy with abortive outcome. Namespaces Article Talk. Views Read Edit View history. Contribute Help Community portal Recent changes Upload file. In other projects Wikimedia Commons.
Digestive system Acute fatty liver of pregnancy Gestational diabetes Hepatitis E Hyperemesis gravidarum Intrahepatic cholestasis of pregnancy. NDL :
Molar pregnancy is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus and will fail to come to term. A molar pregnancy is a gestational trophoblastic disease  which grows into a mass in the uterus that has swollen chorionic villi. These villi grow in clusters that resemble grapes. The products of conception may or may not contain fetal tissue. It is characterized by the presence of a hydatidiform mole or hydatid mole, mola hydatidosa.
2012, Número 3
Twin pregnancy with complete hydatidiform mole and living fetus. Twin pregnancy with a complete hydatidiform mole and a living fetus is a rare entity. According to the few cases described in the literature, this kind of gestation commonly has higher risks of miscarriage, preterm delivery, intrauterine fetal death, bleeding, preeclampsia and persistent trophoblastic disease. This study reports the case of a 20 years old primiparous patient with complete hydatidiform mole and living fetus, whose pregnancy was successfully carried to term. The differential diagnosis with placental degeneration was reached through anatomopathological investigation. ABBI, M.
Only comments seeking to improve the quality and accuracy of information on the Orphanet website are accepted. For all other comments, please send your remarks via contact us. Only comments written in English can be processed. A hydatidiform mole is a benign gestational trophoblastic disease developing during pregnancy. Resulting from an abnormal fertilization characterized by trophoblastic proliferation, normal embryo development is rendered impossible. Hydatidiform moles can be either complete or partial.