Molar pregnancy

Question 1

What is molar pregnancy/trophoblastic disease of pregnancy?

Answer 1

Abnormal proliferation of trophoblastic tissue - hydatidiform mole tumour

Question 1

What is complete trophoblastic disease of pregnancy?

Answer 1

Hydatidiform mole, no normal foetal tissue forms

Question 2

What is partial trophoblastic disease?

Answer 2

Hydatidiform mole, incomplete foetal tissues develop alongside molar tissue

Question 3

What is an invasive mole?

Answer 3

Contains many villi, grow into or through muscle layer of uterus wall
Persistently high hCG

Question 4

What is a choriocarcinoma?

Answer 4

Cytotrophoblasts and syncytiotrophoblasts but no villli form

Question 5

What is a complete mole?

Answer 5

MOST COMON TYPE of hydatidiform
Diffuse trophoblastic hyperplasia
Hydropic swelling of chorionic villi
No foetal tissue or membrane present

Question 6

What genes are hydropic villi and focal trophoblastic are ass with

Answer 6

46XX or 46XY

Question 7

Prognosis of moles

Answer 7

10% invade
3% choriocarcinoma

Question 8

Clinical features trophoblastic disease

Answer 8

Vaginal bleeding - 97%
Uretine larger than date - 51%
Hyperemesis gravidum - 26%
B-hcg >100,000
No foetal heartbeat
Presentation similar to threatened/spontaneous/missed miscarriage

Question 9

What is an incomplete mole

Answer 9

Triploid (69(XXY, XYY, XXX) with chromosome compleemtn from both parents 2 sperm fertilise 1 egg or sperms with reduplication
1% risk of invasion

Question 10

Investigations for UPT B hcg level

Answer 10

U/S
CXR
Features of high risk of neoplasm

Question 11

Treatment for trophoblastic disease

Answer 11

Suction adn curettage
Anti-D rhesis -ve. If bleeding hysterectomy MAY BE NEEDED
Chemotherapy for chorio-carcinoma

Question 12

Follow up for trophoblostic disease/molar preganncy

Answer 12

Register with national centres
B-HCG 2/52 til normal
Follow up montly for 1 year
Follow up 3 monthly in 2nd year

Question 13

What causes a complete mole

Answer 13

Two sperm cells fertilise ovumnt hat contains no genetic material
Sperm combine genetic material and cells start to divide and grow into complete mole - no foetal material forms

Question 14

What causes a partial mole

Answer 14

3 SPERM CELLS fertolose normal ovum containing genetic materal at same time
3 sets of chromosomes - haploid cell
cell divides and multiplies - some foetal material may form

Question 15

What indicates a molar pregnancy over a normal pregnancy

Answer 15

More severe morning sickness
Vaginal bleeding
Increased enlargement of uterus
Abnormally high hCG
Thyrotoxicosis (hCG can mimic TSH and stimulate thyroid to produce excess T3 + T4)

Question 15

What indicates a molar pregnancy over a normal pregnancy

Answer 15

More severe morning sickness
Vaginal bleeding
Increased enlargement of uterus
Abnormally high hCG
Thyrotoxicosis (hCG can mimic TSH and stimulate thyroid to produce excess T3 + T4)

Question 16

US appearnace if molar pregnancy

Answer 16

Snowstorm appearance

Question 17

Diagnosis of molar pregnancy

Answer 17

US + histology of mole after evacuation

Question 18

What is management of molar pregnancy

Answer 18

Evacuation of uterus to remove mole
Specialist centres for management and follow up
hCG levels monitored til return to normal

Question 19

When would a molar pregnancy require systemic chemotherapy

Answer 19

Metastasise of molar pregnancy

Question 20

Treatment of hydatidiform mole

Answer 20

Removed with small operation
Small tube passed into womb