7.6 Molar Pregnancy

Question 1

Gestational trophoblastic disease refers to what 3 entities?

Answer 1

Bengin:
HYDATIFORM mole

Malignant:
INVASIVE mole
CHORIOCARCINOMA (placental cancer)

Question 2

What are the two forms of mole?

Answer 2

Complete mole
Partial mole

(both are premalignant)

Question 3

What is a complete mole made up of?

Answer 3

empty ovum plus a sperm (which doubles chr) or two sperms
46 chr total all paternal
tumour with no fetal material

Question 4

What is a partial mole made up of?

Answer 4

normal ovum plus two sperms
69 chr
tumour with some fetal material forms

Question 5

Which type of mole secretes more hCG? What does this lead to?

Answer 5

A complete mole secretes lots lots more hCG –> symptoms of hCG hyperstimulation:

• hyperthyroidism (same subunit as TSH)
• theca lutein cysts (adnexal pain)
• hyperemesis gravidarum

Question 6

What things might suggest a molar pregnancy in a woman?

Answer 6

• more severe morning sickness
• vaginal bleeding
• increased enlargement of uterus
• higher hCG values
• thyrotoxicosis

Question 7

What is seen on imaging of a molar pregnancy?

Answer 7

ultrasound shows “snowstorm appearance”

partial/incomplete mole may have some foetal parts

Question 8

How do you manage a molar pregnancy?

Answer 8

• evacuation of the uterus
• histology on products to confirm
• refer to trophoblastic disease centre
• monitor hCG levels until normal
• if there are metastases (eg lungs), may need chemotherapy