GINCY -VESICULAR MOLE in pregnancy in obstetric and gynecology

vesicular mole in pregnancy in obstetric and gynaecology

1. SHRI SHANKARACHARYA COLLEGE OF NURSING HUDCO,BHILAI SUBJECT: MIDWIFERY AND OBSTETRICS TOPIC: VESICULAR MOLE DATE: PRESENTED BY: Ms.GINCY THOMAS B.Sc NURSING IV Yr

2. CONTENTS INTRODUCTION DEFINITION TYPES INCIDENCE ETIOLOGY CLINICAL FEATURES DIAGNOSTIC EVALUATION MANAGEMENT COMPLICATION CONCLUSION

3. INTRODUCTION IT IS A CLASSIFICATION OF GESTATIONAL TROPHPBLASTIC DISEASE.THE TERM IS DERIVED FROM HYDATIS (GREEK WORD‘adrop of water’) MOLE (FROM LATIN MOLA ‘false conception’).ABNORMALITY OF EARLY TROPHOBLAST MAY ARISE AS A DEVELOPMENTAL ANOMALY OF PLACENTAL TISSUE AND RESULTS IN THE FORMATION OF A MASS ODEMATOUS AND AVASCULAR VILLI. THE PLACENTA IS REPLACED BY A MASS OF GRAPE LIKE VESICLE KNOWN AS VESICULAR MOLE.THERE IS NO FETUS BUT CONDITION CAN BE FORMED IN THE PRESENCE OF A FETUS

4. VESICULAR MOLE

5. DEFINITION IT IS AN ABNORMAL CONDITION OF THE PLACENTA WHERE THERE ARE PARTLY DEGENERATIVE AND PARTLY PROLIFERATIVE CHANGES IN THE YOUNG CHORIONIC VILLI Dr D.C.DUTTA IT IS AN ABNORMAL CONCEPTION RESULTING IN HYDROPIC SWELLING OF THE CHORIONIC VILLI & TROPHOBLASTIC HYPERPLASIA LEADING TO THE FORMATION OF GRAPE LIKE VESICLES SUDHA SALHAN

6. Incidence: 1:2000 pregnancies in United States and Europe 1:200 in Asia 10 times more in women over 45 years old. The increasing use of ultrasound in early pregnancy has probably led to the earlier diagnosis of molar pregnancy

7. TYPES: It is the result of fertilisation of anucleated ovum ( has no chromosomes) with a sperm which will duplicate giving rise to 46 chromosomes It is the result of fertilisation of an ovum by 2 sperms so the chromosomal number is 69 chromosomes COMPLETE MOLE PARTIAL MOLE

8. Differentiation Between Complete And Partial Mole Partial Mole Complete Mole Feature Present Absent Embryonic or foetal tissue Focal Diffuse Swelling of the villi Focal Diffuse Trophoblastic hyperplasia Less than the date More than the date Uterine size Rare 5-10% Malignant Changes

9. 1)UNKNOWN 2)OVULAR DEFECT 3)IT IS HIGHEST IN TEENAGE PREGNANCY AND WOMEN OVER 35yr OF PREGNANCY 4)FAULTY NUTRITION 5)WOMEN WHO HAVE UNDERGONE OVULATION STIMULATION WITH CLOMIPHENE ETIOLOGY

10. CLINICAL FEATURES USUALLY OCCURS IN 20-24 WEEKS OF GESTATION SYMPTOMS: 1. VAGINAL BLEEDING 2. CONSTITUTIONAL SYMPTOMS- a)PATIENT BECOME SICK WITHOUT ANY APPARENT REASON b)VOMITING OF PREGNANCY BECOMES EXCESSIVE c)BREATHLESSNESS d)THYROTOXIC FEATURES 3. VARYING DEGREE OF LOWER ABDOMINAL PAIN 4. EXPULSION OF GRAPE LIKE VESICLES PER VAGINAM

11. SIGNS: THE PATIENT LOOKS MORE ILL PALLOR FEATURES OF PRE-ECLAMPSIA PER ABDOMEN: SIZE OF UTERUS FEEL OF UTERUS FETAL PARTS ABSENCE OF FETAL HEART SOUND VAGINAL EXAMINATION: INTERNAL BALLOTTEMENT UNILATERAL OR BILATERAL ENLARGEMANT OF THE OVARY FINDING OF VESICLES

12. DIAGNOSTIC EVALUATION: URINE PREGNANCY TEST COMPLETE BLOOD COUNT,Rh GROUPING,SERUM HCG LEVEL HEPATIC,RENAL,& THYROID FUNCTION TEST. ULTRASONOGRAPHY STRAIGHT X-RAY ABDOMEN CT & MRI

13. MANAGEMENT GROUP A: THE MOLE IS IN THE PROCESS OF EXPULSION . SUPPORTIVE THERAPY : 1.VARIABLE AMOUNT OF BLEEDING. DEFINITIVE MANAGEMENT : 1.SUCTION EVACUATION 2.DIGITAL EXPLORATION GROUP B: THE UTREUS REMAINS INERT. 1.BLOOD SHOULD BE KEPT READY PRIOR TO ELECTIVE EVACUATION OF UTREUS. 1.VAGINAL EVACUATION 2.HYSTEROTOMY 3.HYSTERECTOMY

14. CONT………… AFTER THE SUCTION EVACUATION CURETTAGE IS DONE TO REMOVE THE NECROSED DECIDUA & THE ATTACHED VESICLES SO AS TO ACCELERATE INVOLUTION & TO REDUCE IRREGULAR BLEEDING.THE MATERIALS ARE SEND FOR PATHOLOGICAL EXAMINATION.

15. PROPHYLACTIC CHEMOTHERAPY: INDICATION: IF THE HCG FAILS TO BECOME NORMAL WITHIN 4-6 WKS. EVIDENCES OF METASTASIS. FOLLOW UP FACILITIES ARE NOT AVAILABLE. DRUG: METHOTREXATE 2.5mg Tab,I.M

16. COMPLICATION HAEMORRHAGE & SHOCK SEPSIS PERFORATION OF UTERUS PRE ECLAMPSIA COAGULATION FAILURE CHORIOCARCINOMA

17. CONCLUSION

18. THANK Y O U