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Hydatidiform Mole

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References:

  1. Dr. RPS Maternal and Newborn Care: A Comprehensive Guide and Source Book for Teaching and Learning, 2nd Edition, ISBN 978-971-98-2265-3, by Rosalinda Parado Salustiano (pp. 117-195)
  2. Lecturer (V)

AKA Gestational Trophoblastic Disease (GTD). An H-mole is a benign neoplasm of the chorion. The chorion fails to develop into a full-term placenta and instead degenerates into fluid-filled vesicles. Its actual cause is unknown, but risk factors include:

  • Faulty fertilization, one of each sex cells are required e.g. two sperms fertilize one egg
  • Low socio-economic standing
  • Protein deficiency: the building blocks of tissues; poor protein content results in the death of the blastocele, which, if not removed, will multiply and create fluid filled vesicles rapidly.
  • The vesicles rupture from the 16th to 20th week of pregnancy. The resulting discharge is foul and brown.

Classical Signs

  1. Bigger-than-date uterus due to rapid proliferation of blastocele
  2. HCG is abnormally high: 1,000,000 to 2,000,000 IU/L/24 hours. Its normal value is 50,000 to 400,000 IU/L/24 hours.
  3. Absence of fetal signs: outline (via ultrasound), heart rate, movement
  4. Passage of vesicles: confirmatory for H. mole

Management

If no spontaneous evacuation occurs, the best option for management is a D&C done with a curette then ovum forceps followed by suction curettage via large-bore catheter with low-force suctioning. A hysterectomy may also be done if no future pregnancies are desired, or if hCG remains elevated.

  • Afterwards, hCG titer is done to see if remnants were left. If remnants are present, hCG remains high.
  • Pregnancy should be avoided for at least one year to prevent another H. Mole pregnancy, as this may also result in choriocarcinoma (also treated with methotrexate).

Prognosis, Complications

80% of patients experience remission after D&C of the H-mole. However, the chorion may become cancerous; a choriocarcinoma. This is the most dreaded complication. Other complications includes:

  1. Hemorrhage: most serious during the early treatment phase
  2. Uterine perforation
  3. Infection

Graph View