Gynaecology - Molar Pregnancies

Question 1

Molar Pregnancy?

What is it?

Answer 1

• Also known as gestational trophoblastic disease
• Due to xs proliferation of trophoblastic tissue
• Characterised by as either partial or complete
• Also benign or malignant

Question 2

Molar Pregnancy?

Types of Molar Preganancy?

Answer 2

Hydatidiform - Benign

Invasive - Malignant

Choriocarcinoma - Malignant

CAUSES:

• Partial moles are made from both maternal and paternal genetic material
• Complete moles are made only from paternal material

Risk Factors:

• Extremes of maternal age
• Asian ancestry

Question 3

Molar Pregnancy?

Signs and Symptoms?

Answer 3

• Uterus large for dates
• Vaginal bleeding
• Hyperemesis
• Pre-eclampsia
• Hyperthyroidism

Question 4

Molar Pregnancy?

Investigations?

Answer 4

• B-hCG
• BP
• Blood tests: FBC, U&E, TFTs, group and save, rhesus status
• Radiological: Transvaginal USS

Question 5

Molar Pregnancy?

Treatment?

Answer 5

Conservative:

• Patient education
• Contact specialist centres for trophoblastic disease

Medical:

• Prostoglandins +/-mifepristone (anti-progesterone) sometimes used to remove trophoblastic tissue
• Chemotherapy maybe required

Surgical:

• Suction curettage

Question 6

Molar Pregnancy?

Complications?

Answer 6

• Increased risk of trophoblastic disease in further pregnancies
• Trophoblastic disease may become persistent - rquire chemotherapy
• Choriocarcinoma may metastasise