Molar pregnancy

Question 1

What is molar pregnancy?

Answer 1

also known as a hydatidiform mole, forms part of a spectrum of disorders known as gestational trophoblastic disease

Question 2

What is molar pregnancy characterised by?

Answer 2

characterized by an imbalance in the number of chromosomes originating from the mother and father during conception.

Resulting in an abnormal uterus

Question 3

Highest risk females of developing molar pregnancy?

Answer 3

the extreme ends of the fertility age range, specifically those under 16 years of age and over 45 years of age.

Question 4

2 categories for molar pregnancy?

Answer 4

Can be grouped into partial mole and complete mole

Question 5

What is a complete mole molar pregnancy?

Answer 5

Characterized by the formation from a single sperm and an empty egg with no genetic material.

Question 6

What is a partial mole molar pregnancy?

Answer 6

Formed from two sperm and a normal egg. Both paternal and maternal genetic material are present, and there is variable evidence of foetal parts.

Question 7

Clinical features of a molar pregnancy?

Answer 7

Vaginal bleeding

Nausea

Hyperemesis gravidarum

Thyrotoxicosis (due to hCG being closely related to TSH and therefore able to activate its receptors)

Enlargement of the uterus beyond the expected size for gestational age, due to excessive growth of trophoblasts and retained blood.

Question 8

Investigations for molar pregnancy?

Answer 8

B-hCG levels: These are often significantly higher than what would be expected in a normal pregnancy.

Trans-vaginal ultrasound: In a complete molar pregnancy, this may show a ‘snowstorm’ appearance, low resistance of blood vessel flow, and absence of a foetus.

Question 9

What is difference between gestational trophoblastic neoplasia (GTN) and molar pregnancy?

Answer 9

Gestational trophoblastic neoplasia (GTN) is a rare form of cancer. A molar pregnancy can be thought of as a precancerous illness which can occasionally progress to GTN. GTN usually happens when molar pregnancy cells keep growing in your uterus.

Question 10

What are the main symptoms of gestational trophoblastic disease (molar pregnancy)?

Answer 10

Vaginal bleeding
Hyperemesis (large amounts of vomiting)
Large uterus for gestational age I.e. symphysis-fundal height is much higher than gestational age

Question 11

What is symphysis-fundal height?

Answer 11

Distance from the lowest part of their uterus (womb) (near the pubic bone) to the highest part of their uterus. Can be used to check size of baby.

Question 12

What is a normal symphysis-fundal height?

Answer 12

Measured at 20+ weeks pregnancy

The fundal height for a normally growing baby will match the number of weeks of pregnancy — plus or minus 2 centimetre.

Question 13

Appearance of complete molar pregnancy on ultrasound?

Answer 13

“Snow storm” appearance.

Heterogeneous mass in the uterine cavity with multiple anechoic spaces

Question 14

Molar pregnancies can present with hypertension in the first trimester. True/false?

Answer 14

True

Question 15

What cancer can commonly occur as a result of molar pregnancy?

Answer 15

Choriocarcinoma

Question 16

What is gestational trophoblastic disease?

Answer 16

Abnormal cells or tumours that start in the womb from cells that would normally develop into the placenta.

Question 17

Severe hyperemesis is common in ectopic pregnancy and miscarriage. True/false?

Answer 17

False

Severe hyperemesis is common in gestational trophoblastic disease. Not as much in ectopic pregnancy and miscarriage.

Question 18

Is GTD the same as molar pregnancy?

Answer 18

Molar pregnancy is one of a group of conditions known as gestational trophoblastic disease (GTD).

It is sometimes called a hydatidiform mole.

It happens when the fertilisation of the egg by the sperm goes wrong. This leads to the growth of abnormal cells or clusters of water filled sacs inside the womb.

Question 19

Common features of molar pregnancy due to GTD?

Answer 19

“Snowstorm” appearance on ultrasound

New onset hypertension prior to 20 weeks gestation

Larger than normal uterus and very elevated B-HCG reading.

Question 20

Appearance of complete molar pregnancy vs partial?

Answer 20

In a complete molar pregnancy, foetal parts are not identified and there is a higher risk of malignancy compared to a partial molar pregnancy.

Question 21

Dysfunction of the _____ gland, is strongly associated with GTD.

Answer 21

Thyroid

Question 22

For metastatic disease in molar pregnancy, what is usually the first organ affected?

Answer 22

Lungs