2. It is gestational trophoblastic disease in which abnormal
proliferation & degeneration of the trophoblast villi occur.
The cells degenerate &become filled with fluid giving grape
sized vesicles.
Definition
It is an abnormal condition of the placenta where there
are partly degenerative & partly proliferative changes in
the young chorionic villi . These results in the formation of
clusters of small cysts of varying sizes. Because of its
superficial resemblance to hydatid cyst, it is named as
hydatidform mole.
3. TYPES
a partial mole occurs when
an egg is fertilized by two
sperm or by one sperm which
reduplicates itself yielding
the genotypes of 69,XXY
(triploid) or 92,XXXY
(quadraploid).[2] Complete
hydatidiform moles have a
higher risk of developing into
choriocarcinoma — a
malignant tumor of
trophoblast cells — than do
partial moles.
A complete mole is
caused by a single
sperm combining with
an egg which has lost its
DNA (the sperm then
reduplicates forming a
"complete" 46
chromosome set) [2] The
genotype is typically
46,XX (diploid) due to
subsequent mitosis of
the fertilizing sperm,
but can also be 46,XY
(diploid).[
PARTIAL MOLE COMPLETE MOLE
4. Formation of clusters of small cyst of varying
degree
Collectively take appearance of a bunch of
grasp
Villa filled
with fluid
Villi cotinue
to multiply
Uterine
enlargement
Young chorionic villiYoung chorionic villi
Partly degenerate
changes
Partly proliferate
changes
In placenta (abnormal condition )
blood not reaches to fetus
no oxygen &nutrient to fetus
fetus die &become absorbed
No intervillous blood
circulation
choriodecidual spaces
obliterated
maternal blood can not
circulate
creamy white
appearance
Pathophysiology
5. Not definitely known .
FOLLOWING FACTORS & HYPOTHESIS
HAVE BEEN FORWARDED :
Highest in teenage pregnancies &
women over 35 years.
Faulty nutrition like inadequate
intake of protein animal &
carotene.
Disturbed maternal immune
mechanism
Cytogenetic abnormality.
Higher ratio of paternal.
History of prior hydatidiform
mole.
6. Age & parity.
Symptoms :
Vaginal bleeding
Lower abdominal pain
Constitutional symptoms
a) Patient becomes sick without apparent reason
b) Vomitting of pregnancy
c) Breathlessness
d) Thyrotoxic features
Expulsion of grape like vesicles
per vaginum
History of quickening is abscent.
Signs :
Patient looks more ill
Pallor
Features of pre-eclampsia
Per abdomen :
Uterine size more than amenorrhea
Feel of the uterus is firm elastic
Fetal parts are not felt
Absence of fetal heart sound
Vaginal examination :
Internal ballotment can not be
elicited
Unilateral / bilateral enlargement of
the ovary.
Finding of vesicles
7. Full blood count ,ABO & Rh grouping
Hepatic ,Renal & Thyroid function test
Sonograpy
Quantitative estimation of chorionic
gonadotrophin
Straight X-ray abdomen
CT & MRI
8. Hemorrhage & shock
Sepsis
Perforation of the
uterus
Pre-eclampsia with
convulsion
Acute pulmonary
insufficiency
Coagulation failure
Development of
choriocarcinoma
Immediate Late
9. To the OR for D&C and pathology revealed a
complete hydatidiform mole.
10. Evacuating the uterus by uterine
suction or by surgical curettage as
soon as possible after diagnosis.
Hydatidiform mole/molar pregnancy (complete or
incomplete) malignant
11. ACCELERATE
EVACUATION
ACCELERATE
EVACUATION
UTERUS INSERT
IN PROCESS OF
EXPULSION
IN PROCESS OF
EXPULSION
GENTLE CURRETAGE
EVACUATION
GENTLE CURRETAGE
FOLLOWING
EVACUATION
PATIENT YOUNG
DESIRES OF CHILD
PATIENT YOUNG
DESIRES OF CHILD
VAGINAL
HYSTERECTOMY
AGE > 35
H.MOLE
AGE > 35
FAMILY COMPLETED
PERFORATING
H.MOLE
EVACUATION
ABDOMINAL
HYSTERECTOMY
ABDOMINAL
HYSTERECTOMY
CERVIX
UNFAVORABLE
CERVIX
UNFAVORABLE
SLOW DILATATION
OF THE CERVIX
SLOW DILATATION
OF THE CERVIX
OXYTOCIN DRIPOXYTOCIN DRIP
CERVIX FAVORABLE
SUCTION EVACUATION
CERVIX FAVORABLE
SUCTION EVACUATION + ESCALATING OXYTOCINSUCTION EVACUATION + ESCALATING OXYTOCIN
CURETTAGE INCURETTAGE IN
SELECTED CASES
I.V.infusion
Blood transfusion
Suction evacuation
+
oxytocin drip
To correct anemia blood transfusion
To keep blood during evacuation
12. Follow up as a routine ( at least for 6 months )
Monitor maternal serum / urine
Follow up as a routine ( at least for 6 months )
Monitor maternal serum / urine hcg
HCG level plateaus
(OR ) re-elevation
HCG level plateaus
(OR ) re-elevation
ray , CT /MRI brain
Evaluate for persistent trophoblastic
neoplasia ( chest X-ray , CT /MRI brain
, chest, pelvis, serum HCG
Exclude new pregnancyExclude new pregnancy
Monthly follow up for
atleast 6 months
Monthly follow up for
atleast 6 months
HCG levels return to
normal (4 to 6)
HCG levels return to
normal (4 to 6)
Prophylactic cytotoxic therapy
(controversial)
13. Hydatidiform mole on CT, sagittal
view Hydatidiform mole on CT, axial view
Histopathogic image of hydatidiform
mole (complete type). H & E stain.
Hydatidiform mole
14. PROGNOSIS
More than 80% of hydatidiform moles are benign. The outcome
after treatment is usually excellent. Close follow-up is essential.
Highly effective means of contraception are recommended to
avoid pregnancy for at least 6 to 12 months.
In 10 to 15% of cases, hydatidiform moles may develop into
invasive moles. This condition is named persistent trophoblastic
disease (PTD). The moles may intrude so far into the uterine wall
that hemorrhage or other complications develop. It is for this
reason that a post-operative full abdominal and chest x-ray will
often be requested.
In 2 to 3% of cases, hydatidiform moles may develop into
choriocarcinoma, which is a malignant, rapidly-growing, and
metastatic (spreading) form of cancer. Despite these factors
which normally indicate a poor prognosis, the rate of cure after
treatment with chemotherapy is high.
Over 90% of women with malignant, non-spreading cancer are
able to survive and retain their ability to conceive and bear
children. In those with metastatic (spreading) cancer, remission
remains at 75 to 85%, although their childbearing ability is
usually lost.
15. REFERENCE
Bobak, I.M., & Leonard, D. (1995). Text Book Of Maternity & Gynecologic
Care :The Nurse & The Family (4th ed.). Mosby Publication.
Diane., Fraser., & Margret. (2003). Text Book for Midwives (14th ed.).
Elsevier Publishers.
Dutta, D.c., & Hiralal Konar. (2013). Text Book of Obstetrics (7th ed.). Jaypee
Brothers Medical Publishers.
Elizabeth, M (2014). Midwifery for Nurses (2nd ed.). Sathish Kumar Jain
Publishers.
Jacob, A. (2008). A Comprehensive textbook of Midwifery & Gynecological
Nursing (4th ed.). Newyork: Jaypee Brothers Medical Publishers.
Kumari Neelam., Sharma Shivani., & Gupta Preethi. (2010). A Text Book of
Midwifery and Gynecological Nursing.
Ladewig, L. Maternal & Newborn Nursing (3rd ed.). Cumming Publication.
Nurse Midwifery Helen Varney (2nd ed.).
Parulekar, V. S. Textbook for Midwives. (2nd ed.). Mumbai: Vora Medical
Publications.
Raman, A. V. (2014). Maternity nursing (1st ed.). Wolters kluwer publishers.
Richa S. Snapshort In Obstetrical & Gynaecology. Jaypee Brother’s Medical
Publisher.