Hydatidiform mole

USEFUL TO UG AND PG NURSING ASPIRANTS

1. BY JASMI MANU ASSO.PROFESSOR DEPRTMENT OF OBG NURSING RCN HYDATIDI FORM MOLE

2. Definition vesicular mole It is an abnormal condition of the placenta where there are partly degenerative and partly proliferative changes in the young chorionic villi . These result in the formation of clusters of small cysts of varying size.

3. Types There are 2 types of hydatidiform mole Complete mole Partial mole or incomplete mole

4. Incidence It is common in oriental countries Philippines, china, Indonesia, India, central and Latin America and Africa. The highest incidence is in Philippines being 1 in 80 pregnancies and lowest in European countries and USA being about 1 in 2000. Incidence in India is about 1 in 400.

5. Etiology The cause is not exactly known, but appears to be related to the ovular defect. High in teenage pregnancy and women over 35 yrs of age. Prevalence vary with race. Faulty nutrition Disturbed maternal immune mechanism as rise in IgG level and presence of ABO antibody. Cytogenic abnormalities. The higher the ratio of paternal and maternal chromosomes. Previous history of hydatidiform mole.

6. Pathology

7. Pathology Naked eye appearance Microscopic appearance Ovarian changes

8. Clinical features

9. Investigations CBC, ABO and Rh grouping Hepatic, renal and thyroid function test. Sonography of uterus, liver, kidney and spleen. hCG estimation Straight X-ray of abdomen CT scan and MRI

10. Sonography

11. Differential diagnosis

12. Complications Immediate Late

13. Risk of hemorrhage and sepsis is diminished due to early diagnosis and treatment. About 15-20% of complete moles persists to GTN About 5% develop metabolic disorders. 1-4% of risk of reoccurrence of molar pregnancy. The improve prognosis is due to Recognition of high risk factors. Careful follow-up and with BhCG Use of cytotoxic drugs at right time and on right cases Prognosis

14. Management The principles of management Supportive therapy to restore the blood loss and to prevent infections.. To evacuate the uterus as soon as the diagnosis is made. Regular follow up for early detection of persistent trophoblastic disease.

15. The patients are grouped into 2 groups Group A: The mole is in the process of expulsion. Group B: The uterus is inert.

16. Supportive therapy Group A: The patient present with varying amount of bleeding. To start a RL solution. Arrange for blood transfusion. Group B: blood should be kept ready prior to elective evacuation of the uterus.

17. Definite management Group A Simultaneous with supportive therapy 500 ml RL IV infusion and oxytocin (10-20 units) to enhance expulsion suction and evacuation. Negative pressure up to 200-250mm Hg under GA and diazepam Digital exploration under diazepam After evacuation methargin 0.2 mg is given I/M

18. Group B- evacuation of the uterus is done as soon as diagnosis is made . vaginal evacuation Cervix is favorable The preferred method is suction evacuation Oxytocin may be started at risk of bleeding Can be done under GA and diazepam sedation alternatively conventional dilatation of cervix is done after evacuation. During procedure use pulse oximetery.

19. b. cervix is tubular or closed laminaria tent for suction and evacuation. Hysterotomy –It’s a rare procedure Hysterectomy Curettage after vaginal evacuation( send material for histopathological examination) Prophylactic chemotherapy When hCG level fails to come normal in 4-6 week Evidence of metastasis Where follow up facilities are not avilable Follow up Contraceptive advices

20. Unfavorable manifestations Persistent ill health. Abnormal vaginal bleed and continuing amenorrhea. Appearance of respiratory symptoms Sub involution Secondary metastasis in the vagina. hCG titer remains elavated .

21. Partial or incomplete mole In partial hydatidiform mole the affection of the chorionic villi is focal. There is a fetus or at least an amniotic sac.

22. Summary

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