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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
Q

RF for Complete Mole

  • Previous Molar Pregnancy
A

Recurrence rate is 1-2%.

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26
Q

Pathology of Vesicular Mole

A
  • Uterus
  • Ovaries
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27
Q

Uterus Pathology of Vesicular Mole

  • NE
A
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28
Q

Ovaries Pathology of Vesicular Mole

A
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29
Q

Uterus Pathology of Vesicular Mole

  • ME
A
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30
Q

Size of Complete mole

A

> period of amenorrhea (in 50% of cases)

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31
Q

Contents of Complete mole

A

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.

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32
Q

Consistency of Complete mole

A

Soft & doughy

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33
Q

Site of Partial mole

A

≤ period of amenorrhea

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34
Q

Consistency of Partial mole

A

Soft

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35
Q

Contents of Partial mole

A
  • Vesicles
  • Part of Normal Placenta
  • Membranes & Cord
  • Fetus
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35
Q

Compare between Complete Mole & Partial Mole in terms of

  • Villous Edema
  • Trophoblastic Proliferation
  • Blood Vessels in Villi
  • Normal Villi
  • Amnion
  • Fetal Tissues & RBCs
A
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36
Q

Etiology of Theca Lutein Cysts

A

Excessive HCG secretion (causes ovarian hyperstimulation).

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37
Q

Incidence of Theca Lutein Cysts

A

Common è complete mole (25-30%) & rare è partial mole

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38
Q

NE of Theca Lutein Cysts

A

Bilateral ovarian enlargement by multiple variable sized (up to 10 cm) cysts

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39
Q

ME of Theca Lutein Cysts

A

Cysts are lined è luteinized granulosa & theca cells.

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40
Q

Fate of Theca Lutein Cysts

A

Disappear spontaneously èin 2-4 months of treatment of vesicular mole.

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41
Q

Complications of Vesicular Mole

A

Maternal & Fetal

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42
Q

Complications of Vesicular Mole are more common in …….

A

Complete Mole

43
Q

Maternal Complications of Vesicular Mole

A
44
Q

Maternal Complications of Vesicular Mole

  • Hge
A

Due to separation of vesicles & it may be fatal.

44
Q

Fetal Complications of Vesicular Mole

A

Because there is no amniotic sac.

45
Q

Maternal Complications of Vesicular Mole

  • Infection
A

Due to invasion of myometrium (perforating mole).

46
Q

Maternal Complications of Vesicular Mole

  • Metastasis
A

ARDS

46
Q

Maternal Complications of Vesicular Mole

  • Uterine Perforation
A
  • In some cases (more è complete mole), vesicles may get way to uterine vein & then to lung & heart (metastatizing mole).
47
Q

Maternal Complications of Vesicular Mole

  • Trophoblastic Embolization
A

Due to ↑↑ HCG

48
Q

Maternal Complications of Vesicular Mole

  • Hyperemsis Gravidarum
A

Due to ↑↑ HCG.

49
Q

Maternal Complications of Vesicular Mole

  • Preeclampsia
A

May occur before 20 weeks & is due to ↑↑ HCG & uterine distension

50
Q

Maternal Complications of Vesicular Mole

  • Thyrotoxicosis
A

Due to thyrotropic activity of HCG

51
Q

Maternal Complications of Vesicular Mole

  • DIC
A

Due to tissue necrosis → release of thromboplastin → thrombosis.

52
Q

Maternal Complications of Vesicular Mole

  • Complications in Theca Lutein cysts
A

Torsion, rupture or Hge.

53
Q

Maternal Complications of Vesicular Mole

  • Complications of TTT
A

Suction, hysterectomy or chemotherapy

54
Q

Maternal Complications of Vesicular Mole

  • Persistent Trophoblastic Disease
A

15-20% è complete mole & 4% è partial mole.

55
Q

Maternal Complications of Vesicular Mole

  • Late Complications
A

Infertility, abortion & recurrence

56
Q

Fetal Complications of Vesicular Mole

A

In partial mole.

1) Abortion.
2) IUGR or IUFD

57
Q

Dx of Vesicular Mole

A
  • Symptoms & Signs
  • Investigations
58
Q

Dx of Vesicular Mole

  • Symptoms
A
  • Symptoms of Pregnancy
  • Pain
  • Bleeding
  • Spontaneous Expulsion
  • Symptoms of Complications
59
Q

Symptoms of Vesicular Mole

  • Vaginal Bleeding
A
60
Q

What is the specific Symptom of Vesicular Mole?

A

Spontaneous expulsion

61
Q

Symptoms of Vesicular Mole

  • Spontaneous Expulsion
A

Spontaneous expulsion of grape-like vesicles per vagina

62
Q

Symptoms of Vesicular Mole

  • Pain
A

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
Q

Symptoms of Vesicular Mole

  • Symptoms of Complications
A

As hyperemesis gravidarum, preeclampsia or thyrotoxicosis.

64
Q

Dx of Vesicular Mole

  • Signs
A
  • General
  • Abdominal
  • Local
65
Q

Signs of Vesicular Mole

  • General
A

 Breast signs of pregnancy.

 Pallor, tachycardia & hypotension.

 Signs of complications.

66
Q

Signs of Vesicular Mole

  • Abdominal
A

 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
Q

Signs of Vesicular Mole

  • Local
A

 Signs of early pregnancy.

 Expulsion of vesicles may occur during examination (diagnostic).

 Bilateral cystic ovaries.

68
Q

Specifc Signs of Vesicular Mole

A
  • doughy
  • Expulsion of vesicles may occur during examination (diagnostic).
69
Q

INVx for Vesicular Mole

A
  • Urine pregnancy test
  • Serum β-HCG level
  • Ultrasound
  • Histopathological examination
70
Q

INVx for Vesicular Mole

  • Urine Pregnancy Test
A

+ve in high dilution

71
Q

INVx for Vesicular Mole

  • Serum B-HCG
A

Important diagnostic & prognostic test.

  • In complete mole: Level > 100000 mIU/ml is strongly suggestive.
  • In partial mole: Not significantly ↑↑.
72
Q

INVx for Vesicular Mole

  • US
A

Most Important diagnostic test.

  • In complete mole: Snow storm or honey comb appearance.
  • In partial mole: Fetus & placenta + partial molar changes
73
Q

INVx for Vesicular Mole

  • Histopathology
A

Histopathological examination of expelled vesicles.

74
Q

What is the most importantr Diagnostic Test for Vesicular Mole?

A

US

75
Q

DDx of Vesicular Mole

A

➲ Causes of bleeding in early pregnancy.
➲ Causes of oversized uterus.
➲ Causes of snow storm appearance on ultrasound.

76
Q

TTT Aspects of Vesicular Mole

A

Vesicular mole is emergency even if discovered accidentally

  • 1st Aid TTT
  • Preparation of Evacuation (TOP)
  • Evacuation
  • Prophylactic Chemo
  • Follow Up
77
Q

1st Aid Measures in Vesicular Mole

A

Treatment of shock if present.

78
Q

Pretreatment Evaluation in Vesicular Mole

A
79
Q

Pretreatment Preparartion of Vesicular Mole

A

At least 1 liter of matched blood should be ready for transfusion if needed.

80
Q

Methods of Evacuation of Vesicular Mole

A
  • Suction evacuation & curettage
  • Surgical evacuation & curettage
  • Medical evacuation
  • Hysterotomy
  • Hysterectomy
  • Postevacuation complications
81
Q

What is the method of evacuation of Choice in Vesicular Mole?

A

Suction evacuation & curettage

82
Q

Procedure of Suction evacuation & curettage

A

Dilatation of cervix & evacuation of uterine contents (by suction cannula connected to suction apparatus or MVA syringe) followed by gentle curettage.

83
Q

Precautions in Suction evacuation & curettage

A
84
Q

Complications in Suction evacuation & curettage

A
85
Q

Indications of Surgical evacuation & curettage

A

Inferior to suction evacuation.

  • Small sized uterus (< 16 weeks) in absence of suction apparatus.
86
Q

Procedure of Surgical evacuation & curettage

A

Dilatation of cervix & evacuation of uterine contents (by ring or ovum forceps) followed by gentle curettage.

87
Q

Indication of Medical evacuation

A

Large sized uterus (> 16 weeks) in absence of suction apparatus.

88
Q

Drugs Used in Medical evacuation

A

Using PGs or oxytocin.

89
Q

Indications of Hysterotomy in Vesicular Mole

A

Done when suction apparatus isn’t available & uterine size is > 16 weeks è severe bleeding & closed cervix

90
Q

Indications of Hystrectomy in Vesicular Mole

A

Rarely done in certain circumstances:

  • Patient is > 40 years & completed her family.
  • Uterine perforation è internal Hge.
91
Q

What are Postevacuation complication?

A

 ARDS (due to fluid overload or trophoblastic emboli).

 Thyrotoxic crisis (thyroid storm).

 Persistent GTD (due to incomplete evacuation).

 DIC.

92
Q

Prophylactic chemotherapy in vesicular Mole is indicated in …….

A

 High risk cases for development of GTT (see below).

 Suspicion of malignancy during follow up (see below).

93
Q

Objective of Follow up in Vesicular Mole

A

Early detection of malignant transformation.

94
Q

Methods of Follow up in Vesicular Mole

A
  • Contraception
  • Serial serum β-HCG measurement
  • Pelvic examination & ultrasound
95
Q

Methods of Follow up in Vesicular Mole

  • Contraception
A
96
Q

Methods of Follow up in Vesicular Mole

  • Serum B-HCG
A
97
Q

what is the most accepted method for folluw up in Vesicular Mole?

A
  • Serial serum β-HCG measurement
98
Q

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

A

…

99
Q

HCG becomes –ve after 9-12 weeks from evacuation of mole HCG measurement depending on ……

A

a) Initial β-HCG level.

b) Amount of trophoblastic tissue remaining after
evacuation.

100
Q

If HCG level doesn’t ↓↓ or ↑↑ after evacuation, this may be due to:

A

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
Q

Methods of Follow up in Vesicular Mole

  • Pelvic Ex & US
A

Done every 3 months

102
Q

Features suggesting development of choriocarcinoma during follow up

A

 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
Q

Rf for Development of GTT

A

 Age > 40 years.
 Recurrent molar pregnancy.
 Basal HCG level > 100000 mIU/ml.
 Theca lutein cyst > 6 cm.

Y4R2 - Obstetrics I 🤰 (33 decks)

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