Molar pregnancy: Definition, Classification, Clinical feature, Investigation, Treatment, Advice, Complication

 

Molar pregnancy

 

TABLE OF CONTENT:

1.    Definition.

2.    Classification.

3.    Clinical feature.

4.    Investigation.

5.    Treatment.

6.    Advice.

7.    Complication. 

 

Definition of molar pregnancy:

 

Molar pregnancy is an abnormal pregnancy characterized by grossly by multiple grapes like vesicles feeling and distending the uterus usually in the absence of an intact foetus.

 

 

Classification:

 

A.   Complete mole: in complete mole all chorionic villi are changed to hydropic villi, a small amniotic sac may be present, which is difficult to find out. It possesses duel set of paternal gene and none of maternal origin. Karyotype is 46XX or rarely 46XY

B.    Incomplete/Partial mole: in incomplete mole hydropic villi will be present along with the normal villi and a foetus. It is usually associated with chromosomal abnormality, which is triploid (69 XXX, 69XXY) in majority of cases. Malignant change is very rare in this mole.

 

 

Clinical feature:

 

1.    Vaginal bleeding-may be mixed with gelatinous fluid from ruptured cysts

2.    Lower abdominal pain

3.    Nausea and vomiting 

4.    Patient become sick without any apparent reason

5.    Breathlessness

6.    the uterus is doughy (elastic)in consistency

7.    fetal part are not felt, nor any fetal movements

8.    absence of fetal heart sound

 

 

Investigation:

 

1.    CBC, ABO and Rh grouping

2.    Hepatic, thyroid, renal function test

3.    USG of whole abdomen

4.    Plain X-ray of abdomen

5.    Serum HCG quantitative assay

6.    CT scan & MRI

7.    X-ray of chest

 

Treatment:

 

Supportive Treatment:

1.    Correction of anemia and infection if there is   any

2.    Rh (-ve) mother should be received Rh Ig.

3.    Routine follow up is mandatory for at least      1 year.

4.    Surgical:

5.    Suction evacuation is the method of treatment

6.    Hysterectomy is the choice of treatment with the mole in situ or after evacuation in woman age >40 years and or has 3 or more children.

 

Advice:

After evacuation of mole patient is not get pregnant at least for 2 years. If patient desires, may be pregnant after a minimum of 6 months, following the negative of HCG titer.

 

 

Complication:

 

1.    Hemorrhage and shock

2.    Sepsis

3.    Perforation of uterus

4.    Acute pulmonary insufficiency

5.    Coagulation failure

6.   Choriocarcinoma.