Molar pregnancy

Question 1

What is it?

Answer 1

Trophoblastic tissue which normally invades the endometrium proliferates more aggressively than usual
HCG secreted in excess

Question 2

Hydatiform mole

Answer 2

Proliferation localised and non-invasive

Subdivided into complete and partial

Question 3

Complete mp;e

Answer 3

Entirely paternal in origin
Sperm fertilises empty oocyte and undergoes mitosis
Diploid tissue
No fetal tissue, just proliferation of swollen chronic villi

Question 4

Partial mole

Answer 4

Triploid
Two sperm, one oocyte
Variable evidence of fetus

Question 5

Invasive mole

Answer 5

Characteristics of malignant tissue

Only present locally within the uterus

Question 6

Choriocarcinoma

Answer 6

Characteristics of malignant tissue

Metastases outside the uterus

Question 7

Clinical features

Answer 7

Vaginal bleeding, early and may be heavy
Severe vomiting
Uterus large
Early pre-eclampsia and hyperthyroidism

Question 8

Investigations

Answer 8

US shows ‘snowstorm’ appearance of swollen villi (complete mole)
Diagnosis only confirmed histologically
Serum hCG may be very hiigh

Question 9

Management

Answer 9

Tissue removed by suction curettage
Serial blood or urine hCG - high levels suggestive of malignancy
Registered with a supraregional centre
Pregnancy and COC avoided until hCG levels normal as may increase need for chemo

Question 10

Complications

Answer 10

Recurrence

Malignancy