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Introduction
Background
Pathophysiology
Frequency
United States
International
Mortality/Morbidity
A hydatidiform mole is considered malignant if metastases
or destructive invasion of the myometrium (ie, invasive
mole) occurs, or when the serum hCG levels plateau or rise
during the period of follow-up and an intervening pregnancy
is excluded. Malignancy (see eMedicine's article Gestational
Trophoblastic Neoplasia) is diagnosed in 15-20% of patients
with a complete hydatidiform mole and 2-3% of partial
moles.12,13 Lung metastases are found in 4-5% of patients
with a complete hydatidiform mole and rarely in cases of
partial hydatidiform moles.14,15
Race
Sex
Age
Clinical
History
• Complete mole: The typical clinical presentation of
complete molar pregnancies has changed with the
advent of high-resolution ultrasonography. Most moles
are now diagnosed in the first trimester before the
onset of the classic signs and symptoms.20,21
o Vaginal bleeding: The most common classic
symptom of a complete mole is vaginal bleeding.
Molar tissue separates from the decidua, causing
bleeding. The uterus may become distended by
large amounts of blood, and dark fluid may leak
into the vagina. This symptom occurs in 50% of
cases.
o Hyperemesis: Patients may also report severe
nausea and vomiting. This is due to
extremely high levels of human chorionic
gonadotropin (hCG).
o Hyperthyroidism: Signs and symptoms of
hyperthyroidism can be present due to stimulation
of the thyroid gland by the high levels of
circulating hCG or by a thyroid stimulating
substance (ie, thyrotropin) produced by the
trophoblasts.22
• Partial mole: Patients with partial mole do not have the
same clinical features as those with complete mole.
These patients usually present with signs and
symptoms consistent with an incomplete or missed
abortion.
o Vaginal bleeding
o Absence of fetal heart tones
Physical
• Complete mole
o Size inconsistent with gestational age: A uterine
enlargement greater than expected for gestational
age is a classic sign of a complete mole.
Unexpected enlargement is caused by excessive
trophoblastic growth and retained blood. However,
patients present with size-appropriate
enlargement or smaller-than-expected
enlargement at a similar frequency.
o Preeclampsia: Pelvic ultrasonography has resulted
in the early diagnosis of most cases of
hydatidiform mole and preeclampsia is seen in
less than 2% of cases.21
o Theca lutein cysts: These are ovarian cysts greater
than 6 cm in diameter and accompanying ovarian
enlargement. These cysts are not usually palpated
on bimanual examination but are identified by
ultrasonography. Patients may report pressure or
pelvic pain. Because of the increased ovarian size,
torsion is a risk. These cysts develop in response
to high levels of beta-hCG. They spontaneously
regress after the mole is evacuated, but it may
take up to 12 weeks for complete regression.
• Partial mole
o Uterine enlargement and preeclampsia is reported
in only 5% of patients.23
o Theca lutein cysts, hyperemesis, and
hyperthyroidism are extremely rare.
• Twinning
o Twinning with a complete mole and a fetus with a
normal placenta has been reported. Cases of
healthy infants in these circumstances have been
reported.24,8
o Women with coexistent molar and normal
gestations are at higher risk for developing
persistent disease and metastasis25 . Termination
of pregnancy is a recommended option.
o The pregnancy may be continued as long as the
maternal status is stable, without hemorrhage,
thyrotoxicosis, or severe hypertension. The patient
should be informed of the risk of severe maternal
morbidity from these complications.26
o Prenatal genetic diagnosis by chorionic villus
sampling or amniocentesis is recommended to
evaluate the karyotype of the fetus.
Causes
Hydatidiform mole
Natural history
Parental origin
Treatment
Prognosis
Symptoms
Diagnosis
Prognosis
Treatment
SOURCES;
http://www.merck.com/mmhe/sec22/ch252/ch252h.html
http://emedicine.medscape.com/article/254657-overview
http://en.wikipedia.org/wiki/Hydatidiform_mole