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Y4R2 - Obstetrics I 🤰 > L10: Vesicular Mole > Flashcards

L10: Vesicular Mole Flashcards

1
Q

Def of GTD

A

Term used for spectrum of trophoblastic roliferative disorders.

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2
Q

Classification of GTD

A
  • Benign: Vesicular mole (discussed in obstetrics).
  • Malignant: Gestational trophoblastic tumor (discussed in gynecology).
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3
Q

Def of Vesicular Mole

A
  • Benign trophoblastic proliferative disorder in which products of conception are totally or partially replaced by vesicular structure.
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4
Q

Synonyms of Vesicular Mole

A

Hydatidiform mole or molar pregnancy.

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5
Q

Incidence of Vesicular Mole

A

1/1500 in most of world.

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6
Q

Pathogenesis of Vesicular Mole

A
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7
Q

Types of Vesicular Mole

A
  • Complete (classic) mole
  • Partial (incomplete) mole
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8
Q

Def of Complete (classic) mole

A
  • All products of conception are changed
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9
Q

RF for Complete (classic) mole

A

Related to certain risk factors

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10
Q

Pathogenesis of Complete (classic) mole

A
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11
Q

Karyotype in Complete (classic) mole

A

46XX (90%) or 46XY (10%)

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12
Q

Sources of Chromosomes in Complete (classic) mole

A

All conceptus chromosomes are paternal (paternal androgenesis)

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13
Q

Def of Partial (incomplete) mole

A

Only part of placenta is changed into vesicles

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14
Q

RF for Partial (incomplete) mole

A

Not related to risk factors

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15
Q

Pathogenesis of Partial (incomplete) mole

A
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16
Q

Karyotype in Partial (incomplete) mole

A

69XXY or 69XXX (triploid)

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17
Q

Source of chromosomes in Partial (incomplete) mole

A

2 sets of conceptus chromosomes are paternal & 1 set is maternal

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18
Q

RF for Complete Mole

A
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19
Q

RF for Complete Mole

  • Age
A

More common in extremities of reproductive age (< 20 & > 40 years)

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20
Q

RF for Complete Mole

  • Parity
A

More common è low parity (GTT is more common è high parity).

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21
Q

RF for Complete Mole

  • Race
A

Highest incidence (1/125) is in south east Asia (specially Philippines).

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22
Q

RF for Complete Mole

  • SES
A

More in poor classes.

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23
Q

RF for Complete Mole

  • Diet
A

More common in rice eating & spicy cooking populations.

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24
Q

RF for Complete Mole

  • Genetic Factors
A

Trisomy 16 is common association.

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25
RF for **Complete Mole** - Previous Molar Pregnancy
Recurrence rate is 1-2%.
26
Pathology of **Vesicular Mole**
- Uterus - Ovaries
27
Uterus Pathology of **Vesicular Mole** - NE
28
Ovaries Pathology of **Vesicular Mole**
29
Uterus Pathology of **Vesicular Mole** - ME
30
Size of **Complete mole**
> period of amenorrhea (in 50% of cases)
31
Contents of **Complete mole**
Filled è grape like vesicles which are: - Attached to each others & to uterine wall. - Unilocular & variable in size & shape. - Thin walled & contain clear watery fluid.
32
Consistency of Complete mole
Soft & doughy
33
Site of **Partial mole**
≤ period of amenorrhea
34
Consistency of **Partial mole**
Soft
35
Contents of **Partial mole**
- Vesicles - Part of Normal Placenta - Membranes & Cord - Fetus
35
Compare between Complete Mole & Partial Mole in terms of - Villous Edema - Trophoblastic Proliferation - Blood Vessels in Villi - Normal Villi - Amnion - Fetal Tissues & RBCs
36
Etiology of **Theca Lutein Cysts**
Excessive HCG secretion (causes ovarian hyperstimulation).
37
Incidence of **Theca Lutein Cysts**
Common è complete mole (25-30%) & rare è partial mole
38
NE of **Theca Lutein Cysts**
Bilateral ovarian enlargement by multiple variable sized (up to 10 cm) cysts
39
ME of **Theca Lutein Cysts**
Cysts are lined è luteinized granulosa & theca cells.
40
Fate of **Theca Lutein Cysts**
Disappear spontaneously èin 2-4 months of treatment of vesicular mole.
41
Complications of **Vesicular Mole**
Maternal & Fetal
42
Complications of **Vesicular Mole** are more common in .......
Complete Mole
43
Maternal Complications of **Vesicular Mole**
44
Maternal Complications of **Vesicular Mole** - Hge
Due to separation of vesicles & it may be fatal.
44
Fetal Complications of **Vesicular Mole**
Because there is no amniotic sac.
45
Maternal Complications of **Vesicular Mole** - Infection
Due to invasion of myometrium (perforating mole).
46
Maternal Complications of **Vesicular Mole** - Metastasis
ARDS
46
Maternal Complications of **Vesicular Mole** - Uterine Perforation
- In some cases (more è complete mole), vesicles may get way to uterine vein & then to lung & heart (metastatizing mole).
47
Maternal Complications of **Vesicular Mole** - Trophoblastic Embolization
Due to ↑↑ HCG
48
Maternal Complications of **Vesicular Mole** - Hyperemsis Gravidarum
Due to ↑↑ HCG.
49
Maternal Complications of **Vesicular Mole** - Preeclampsia
May occur before 20 weeks & is due to ↑↑ HCG & uterine distension
50
Maternal Complications of **Vesicular Mole** - Thyrotoxicosis
Due to thyrotropic activity of HCG
51
Maternal Complications of **Vesicular Mole** - DIC
Due to tissue necrosis → release of thromboplastin → thrombosis.
52
Maternal Complications of **Vesicular Mole** - Complications in Theca Lutein cysts
Torsion, rupture or Hge.
53
Maternal Complications of **Vesicular Mole** - Complications of TTT
Suction, hysterectomy or chemotherapy
54
Maternal Complications of **Vesicular Mole** - Persistent Trophoblastic Disease
15-20% è complete mole & 4% è partial mole.
55
Maternal Complications of **Vesicular Mole** - Late Complications
Infertility, abortion & recurrence
56
Fetal Complications of **Vesicular Mole**
In partial mole. 1) Abortion. 2) IUGR or IUFD
57
Dx of **Vesicular Mole**
- Symptoms & Signs - Investigations
58
Dx of **Vesicular Mole** - Symptoms
- Symptoms of Pregnancy - Pain - Bleeding - Spontaneous Expulsion - Symptoms of Complications
59
Symptoms of **Vesicular Mole** - Vaginal Bleeding
60
What is the specific Symptom of **Vesicular Mole**?
Spontaneous expulsion
61
Symptoms of **Vesicular Mole** - Spontaneous Expulsion
Spontaneous expulsion of grape-like vesicles per vagina
62
Symptoms of **Vesicular Mole** - Pain
Usually absent but there may be: - Dull aching pain: Due to uterine distension. - Colicky pain: Due to uterine contraction. - Stabbing pain: Due to uterine invasion or perforation. - Sharp pain: Due to complication in theca lutein cysts.
63
Symptoms of **Vesicular Mole** - Symptoms of Complications
As hyperemesis gravidarum, preeclampsia or thyrotoxicosis.
64
Dx of **Vesicular Mole** - Signs
- General - Abdominal - Local
65
Signs of **Vesicular Mole** - General
 Breast signs of pregnancy.  Pallor, tachycardia & hypotension.  Signs of complications.
66
Signs of **Vesicular Mole** - Abdominal
 Uterine size is > period of amenorrhea (may be ≤ period of amenorrhea in partial mole or if partial expulsion occurs).  Uterus is soft & doughy.  No palpable fetal parts, ballottement or audible FHS (in complete mole).
67
Signs of **Vesicular Mole** - Local
 Signs of early pregnancy.  Expulsion of vesicles may occur during examination (diagnostic).  Bilateral cystic ovaries.
68
Specifc Signs of **Vesicular Mole**
- doughy - Expulsion of vesicles may occur during examination (diagnostic).
69
INVx for **Vesicular Mole**
- Urine pregnancy test - Serum β-HCG level - Ultrasound - Histopathological examination
70
INVx for **Vesicular Mole** - Urine Pregnancy Test
+ve in high dilution
71
INVx for **Vesicular Mole** - Serum B-HCG
Important diagnostic & prognostic test. - In complete mole: Level > 100000 mIU/ml is strongly suggestive. - In partial mole: Not significantly ↑↑.
72
INVx for **Vesicular Mole** - US
Most Important diagnostic test. - In complete mole: Snow storm or honey comb appearance. - In partial mole: Fetus & placenta + partial molar changes
73
INVx for **Vesicular Mole** - Histopathology
Histopathological examination of expelled vesicles.
74
What is the most importantr Diagnostic Test for **Vesicular Mole**?
US
75
DDx of **Vesicular Mole**
➲ Causes of bleeding in early pregnancy. ➲ Causes of oversized uterus. ➲ Causes of snow storm appearance on ultrasound.
76
TTT Aspects of **Vesicular Mole**
**Vesicular mole is emergency even if discovered accidentally** - 1st Aid TTT - Preparation of Evacuation (TOP) - Evacuation - Prophylactic Chemo - Follow Up
77
1st Aid Measures in **Vesicular Mole**
Treatment of shock if present.
78
Pretreatment Evaluation in **Vesicular Mole**
79
Pretreatment Preparartion of **Vesicular Mole**
At least 1 liter of matched blood should be ready for transfusion if needed.
80
Methods of Evacuation of **Vesicular Mole**
- Suction evacuation & curettage - Surgical evacuation & curettage - Medical evacuation - Hysterotomy - Hysterectomy
81
What is the method of evacuation of Choice in Vesicular Mole?
Suction evacuation & curettage
82
Procedure of **Suction evacuation & curettage**
Dilatation of cervix & evacuation of uterine contents (by suction cannula connected to suction apparatus or MVA syringe) followed by gentle curettage.
83
Precautions in **Suction evacuation & curettage**
84
Complications in **Suction evacuation & curettage**
85
Indications of **Surgical evacuation & curettage**
**Inferior to suction evacuation.** - Small sized uterus (< 16 weeks) in absence of suction apparatus.
86
Procedure of Surgical evacuation & curettage
Dilatation of cervix & evacuation of uterine contents (by ring or ovum forceps) followed by gentle curettage.
87
Indication of **Medical evacuation**
Large sized uterus (> 16 weeks) in absence of suction apparatus.
88
Drugs Used in **Medical evacuation**
Using PGs or oxytocin.
89
Indications of Hysterotomy in **Vesicular Mole**
Done when suction apparatus isn't available & uterine size is > 16 weeks è severe bleeding & closed cervix
90
Indications of Hystrectomy in **Vesicular Mole**
Rarely done in certain circumstances: - Patient is > 40 years & completed her family. - Uterine perforation è internal Hge.
91
What are Postevacuation complication?
 ARDS (due to fluid overload or trophoblastic emboli).  Thyrotoxic crisis (thyroid storm).  Persistent GTD (due to incomplete evacuation).  DIC.
92
Prophylactic chemotherapy in vesicular Mole is indicated in .......
 High risk cases for development of GTT (see below).  Suspicion of malignancy during follow up (see below).
93
Objective of **Follow up in Vesicular Mole**
Early detection of malignant transformation.
94
Methods of **Follow up in Vesicular Mole**
- Contraception - Serial serum β-HCG measurement - Pelvic examination & ultrasound
95
Methods of **Follow up in Vesicular Mole** - Contraception
96
Methods of **Follow up in Vesicular Mole** - Serum B-HCG
97
what is the most accepted method for folluw up in Vesicular Mole?
- Serial serum β-HCG measurement
98
Serum β-HCG is measured 48 hours after evacuation then weekly till 3 successive results are –ve then monthly for next 6 months then yearly
...
99
HCG becomes –ve after 9-12 weeks from evacuation of mole HCG measurement depending on ......
a) Initial β-HCG level. b) Amount of trophoblastic tissue remaining after evacuation.
100
If HCG level doesn't ↓↓ or ↑↑ after evacuation, this may be due to:
If HCG level doesn't ↓↓ or ↑↑ after evacuation, this may be due to: a) Pregnancy. b) Persistent GTD (due to incomplete evacuation or GTT).
101
Methods of **Follow up in Vesicular Mole** - Pelvic Ex & US
Done every 3 months
102
Features suggesting development of choriocarcinoma during follow up
 β-HCG level doesn't ↓↓ (plateau), ↑↑ after its ↓↓ or becomes +ve after being –ve.  Persistent or new vaginal bleeding.  Subinvoluted uterus or persistent cystic ovaries.  Appearance of symptoms & signs of secondaries.
103
Rf for Development of GTT
 Age > 40 years.  Recurrent molar pregnancy.  Basal HCG level > 100000 mIU/ml.  Theca lutein cyst > 6 cm.

Y4R2 - Obstetrics I 🤰 (59 decks)

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