Vesicular mole /Hydatidiform mole.pptx

It contains introduction, definition, risk , etiology, clinical manifestations, complications and management.

It's also known as v mole /vesicular mole/hydatidiformole /grape like structure etc..

The contain is taken from mostly DC DATTA , HIRALA KONAR.

All type of management is given inside like medical, surgical and nursing management.

1. D E F I N I T I ON It is an abnormal condition of the placenta where there are partly degenerative and partly proliferative change in the young chorionic villi The result in formation of cluster of small cyst of varying size. it is a type of benign neoplasia with malignant potential. This is a type of gestational trophoblastic disease

2. It is and abnormal condition of the placenta where there are partly degenerative and partly proliferative change in the young chorionic villi

3. T Y P E S O F V E S I C U LAR M O L E C o m p l e te P a r t i a l ( I n c o m p lete )

4. E T I O L OGY Unknown but some of the factor or hypothesis put forward are :- 1) Prevalence teenage pregnancy or women above 35 years. 2) P r evalence in some race and ethnic origin (more in philipino, Japan less in USA, Europe) 3) F aulty nutrition (less protein, animal fat ,carotene etc) 4) D isturbed maternal immune mechanisms

5. C o n t . . 5) S een in AB blood group as they have not ABO antibody. 6) C ytogenetic abnormality (chromosomal abnormality) 7 ) History of prior hydatidiform mole

6. C L I N ICAL F E A T URE S Women are usually teenage or adult with high parity. Patient come with history of 8 to 12 week of amenorrhea. symptoms- Patient come with complaint of vaginal bleeding suggestive of incomplete or threatened abortion. Blood looks like white currant in red currant juice (due to gelatine substance from Rapture cyst) Patient also complain of lower abdominal pain (which may due to overstretching of uterus or uterus perforation or infection or uterine contraction To expel out the contents.

7. C o n t . . . . Other symptoms are patient become sick without any Apparent reason. V omiting become excessive. Breathlessness due to pulmonary embolism. Thyrotoxic features like tremor, tachycardia may be present due to raised chorionic thyrotropin.

8. SYMPTOMS Expulsion of grape like vesicular per vaginum. History of quickening absent

9. C o n t . . Sign- features of pregnancy are evident. patient look very ill preeclampsia features are evident

10. Per abdomen examination findings- 1 .The size uterus is more than period of gestation. 2. The feel of uterus is firm and Elastic(doughy) because no fetus, amniotic fluid. 3. No fetal parts felt. 4 . No FHS heard

11. Vaginal examination - Internal ballottement cannot be elicited . -Uni or bilateral elargement of ovary. - Vesicles may be found in vaginal examination - I f os is dilated blood clot and vesicles are felt instead of membranes.

12. I N V E S T I GATION CBC, ABO, Rh typing. LFT, KFT , thyroid profile. USG (snow storm appearance) Estimation of HCG >100,000mlIU/ml) X-ray abdomen- Negative fetal shadow. X-ray chest to rule out any pulmonary embolism or metastasis CT/MRI not more required Definitive diagnosis after histological examination of products evacuated.

13. C O M P L I C A T I ON immediate hemorrhage sepsis perforation of uterus preeclampsia eclampsia acutepulmonary insufficiency coagulation failure Late : Choriocarcinoma

14. M A N A G EMENT Principle of management 1)Empty uterus by suction evacuation as soon as diagnosis is made 2) Supportive therapy according to patient condition and need (anaemia infection) 3) Counseling for regular follow up

15. Patient are divided into two group G r o u p A : -Mole is in process of expulsion Group B: -uterus is inert

16. Supportive T h e r a py Put IV Collect blood and send for grouping and cross matching Arrange for blood Start IV RL Start and antibiotics to prevent infection

17. Definitive management: Suction evacuation is most safe and effective method even if 28 wks of gestation.so management according to 2 groups

18. M a n a g e ment Group A : Cervix is favourable 1. suction evacuation 2. or Dilatation and evacuation 3. or digital exploration and removal of mole by ovum forceps after evacuation injection methargine 0.2 mg IM

19. Group B : Cervix tubular & closed 1)slow dilation by laminaria tent, followed by suction evacuation 2) or vaginal Misoprost PGE2 400 microgram 3 hours prior & suction evacuation

20. I ndication of hysterectomy 1.patient more than 35 yrs 2. patient completed family irrespective of age 3 Uncontrol hemorrhage after surgery Indication for hysterotomy: 1. profuse vaginal bleeding 2.Cervix is unfavourable 3.Accidental perforation

21. C o n t . . Send uterus for history after hysterectomy. Anti D to All RH negative women

22. F O L L O W U P All the case to followed up for at least 1 year. objective is to be diagnosed persistent trophoblastic disease and choriocarcinoma

23. Continue . . Interval of follow up 1.every week till HCG is negative 2.once negative every month till 6 month. 3. patient must not get pregnant during follow-up .so advice well on contraception

24. F o l l ow up protocol during each visit patient should under go 1 .History taking especially enquire about irregular vaginal bleeding, cough, breathlessness 2. abdominal and pelvic examination check for involution of uterus, size of ovary , Malignant deposit in anterior vaginal wall .

25. C o n t . . . 3.investigation. a )detection of HCG in urine /serum till it become negative. b) chest X-ray to be looked for sign of metastasis during follow of if following event happen then we have to start chemotherapy for patient

26. during follow of if following event happen then we have to start chemotherapy for patient A.) if HCG HCG not falling Falling In stipulated time (10 to12 wk) B)If HCG is rising C)post evacuation bleeding D)when follow-up is not sure E) evidence of metastasis. F)Risk factors suggest chance of malignancy prophylactic chemotherapy may be also given in high risk group and follow-up facility is poor.

27. Chemotherapy regimen injection Methotrexate 1mg/kg/ IM on days 1,3,5 and 7 with folinic acid 0.1 mg/kg IM on days 2,4,6 and 8. Repeated every 7 days. Total 3 courses are given .

28. Contraceptive method The patient is traditionally advise not to be pregnant for at least one year Thus if patient so Desire she o f may be pregnant after a minimum of six months following the negative HCG t i t e r use of contraceptio n

29. B i b l i o g r a phy D C D U T T A ' S " t e x t b o o k s o f O B S T E T RICS " , 9 t h e d i t i on , published b y j a y p e e , c h a p - 1 6 , p g n o 1 8 1 - 1 8 6