Molar Pregnancy

Question 1

what is a molar pregnancy?

Answer 1

• non-viable fertilised egg implants in the uterus and fails to come to term
• It is a type of gestational trophoblastic disease

Question 2

what is a hydiatiform mole?

what is a partial and complete mole?

Answer 2

• commonest kind of trophoblastic disease, where overgrowth is benign
• partial mole: maternal and paternal origin, placental overgrowth and proliferation. Two sperm enter the egg forming triploidy (abnormal foetus)
• complete mole: entirely paternal, where the whole placenta is abnormal and rapid growth. One sperm enters an empty egg and divides(causes swollen chorionic villi)

Question 3

what are the risks of these moles?

Answer 3

• local invasive within the uterus (malignant)
• choriocarcinoma: rare but curable form of cancer where placenta becomes malignant. This can arise from molar pregnancy or otherwise normal pregnancy.
• persistent gestational trophoblastic disease: where part of the mole remains in any part of the body despite treatment. Causes persistently high B-HCG

Question 4

how do partial moles present?

Answer 4

• missed abortion (normal/ partial elevation of BHCG)
• complete moles have abnormal vaginal bleeding (85%)
• severe hyperemesis (raised HCG)
• early pre-eclampsia and hyperthyroidism

Question 5

what is the management of moles?

Answer 5

• uterine evacuation (ERCP)
• complete molar pregnancy (no foetal parts) evacuation by suction procedure.
• medical evacuation for a partial mole, followed by surgical evacuation.
• follow up as risk of malignancy after

Question 6

what is a functional ovarian cyst?

What happens to most of them?

what is protective against these?

Answer 6

• enlargements of ovary occurring during reproductive years
• persistently large follicles or corpus lutem
• spontaneously resolve within 4-6 weeks
• COCP

Question 7

what might make you think an ovarian cyst is malignant on ultrasound?

Answer 7

• irregular borders

- ascites, papillations/ septations

Question 8

what is a dermoid cyst?

Answer 8

• represents 25% of all ovarian neoplasms
• originate from primordial germ cells
• can be bilateral and up to 25 cm
• rupture painful

Question 9

what other tumours are there?

Answer 9

• serous cystadenomas:

- mutinous cystadenomas

Question 10

what is Meig’s syndrome?

Answer 10

• ascites, hydrothorax, hydropericardium with an ovarian mass

Question 11

how are ovarian smile cysts managed?

Answer 11

• monitor for 4-6 weeks,

- if size >10cm then removal