Early Pregnancy Complications

Question 1

Risk factors for molar pregnancy

Answer 1

More in Asians, extreme reproductive age.

Question 2

What is the difference between complete and partial molar pregnancies ?

Answer 2

Complete: Paternal origin. 46 XX. No fetal tissue, Sperm fertilizes empty ovum and undergoes mitosis

Partial : Triploid, fetus present
2 sperms fertilizing one oocyte

Question 3

When does a molar pregnancy become Choricarcinoma?

Answer 3

• Invasive mole: Invasion locally

* Choricarcinoma: metastases

Question 4

Clinical features of molar pregnancies

Answer 4

• Vaginal bleeding
• Vomiting
• Examination: Large uterus, preeclampsia, Hyperthyroidism

Question 5

Investigations of molar pregnancies

Answer 5

Full blood count, blood group and rhesus antibody serology
Serum human chorionic gonadotrophin (hCG) [hCG levels are often > 100 000 iu/l with complete hydatidiform mole (CHM) but not partial hydatidiform mole (PHM)]
Pelvic ultrasound
Histopathological analysis of products of conception (POC)
Registration of confirmed molar pregnancy to UK centres for hCG surveillance

Question 6

Ultrasound findings molar pregnancies

Answer 6

Placental mass containing multiple echoes (holes) (so-called snowstorm vesicular pattern) without an associated embryo and bilateral ovarian thecal luteal cysts.
Ultrasound of PHM
Presence of an embryo,
may also show features consistent with delayed or incomplete miscarriage.
However, in general, ultrasound is poorly predictive of a molar pregnancy diagnosis (as confirmed by histopathology), with accuracy rates of only 40–60%

Question 7

Treatment of molar pregnancy

Answer 7

SURGICAL: •The preferred treatment for women who wish to preserve their fertility is surgical evacuation of the uterus using suction curettage. In complete moles, a suction catheter of 12 mm diameter is usually sufficient to evacuate the uterus, owing to the absence of fetal parts.

MEDICAL: Where possible, medical termination of molar pregnancies, including prostaglandin cervical preparations, should be avoided. This is due to the mainly theoretical risk of increasing trophoblastic embolisation by inducing uterine contractions.

Give Anti-D at time of evacuation