Molar Pregnancy (H-Mole) Flashcards
Refers to a spectrum of pregnancy-related conditions that involve abnromal growth of the trophoblastic cells that normally form the placenta.
Gestational Trophoblastic Disease (GTD)
This refers to an abnormal pregnancy that occurs when the fertilzed egg does not develop properly leading to abnormal growth of the placenta.
- A type of GTD
- Can happen with or without fetal development
Hydatidiform Mole
Which cells produce the embryo and the placenta.
1) Embryoblast - Embryo to fetus
2) Trophoblast - Placenta
2 Types of Molar Pregnancy
1) Partial Molar Pregnancy
2) Complete Molar Pregnancy (Monospermic / Dispermic)
Types of Molar Pregnancy
- Some fetal tissue may develop, but it is typically malformed & cannot survive
- Placenta grows abnormally
Partial Molar Pregnancy
Type of Molar Pregnancy
- Abnormal Proliferation of trophoblastic cells
- no embryo develops (only abnormal placental tissue)
- Placenta becomes a mass of fluid-filled cysts that resemble grap clusters
- Fertilized egg has no genetic material from the mother, all 46 chromosomes from the father (no fetus)
Complete Molar Pregnancy
Types of Complete Pregnancy
One sperm fertilizes an empty ovum (woman’s egg has no genetic material in it) that is why the father’s chromosomes are duplicated because there needs to be 46 chromosomes in 1 pair for conception to occur
Monospermic complete molar pregnancy
Two sperms fertilize an empty ovum that is why only the father’s genetic materials are present to form the 46 chromosomes in 1 pair for conception to occur.
Dispermic complete molar pregnancy
This happens when a sperm fertilizes an egg that did not undergo division (meiosis) or vice-versa (46 chromosomes from mom + 23 from dad)
Monospermic Partial H-mole
This happen when the ovum which contains mom’s genetic material is fertilized by 2 sperms. Normally, only 46 chromosomes should be present for a normal pregnancy to develop, but since 2 sperms fertilized the same egg, the resulting karyotype is abnormal with 69 chromosomes ( 46 from dad + 23 from mom)
Dispermic Partial H-mole
Causes/Risk Factors of H-mole
1) Maternal Age
2) Previous Molar Pregnancy
3) Nutritional Deficiencies - Low folic acid
4) Genetic factors
5) Asian Descent
Signs and Symptoms of H-Mole
1) Severe nausea and vomiting (due to high hCG levels)
2) Positive urine hCG & abnormally high serum hCG levels
3) Uterus larger thant expected for gestational age
4) No fetal heartbeat & fetal movement detected
5) Hyperthyroidism symptoms
6) Pre-eclmapsia before 20 weeks
7) Hyperemesis gravidarum
8) Pelvic pain or pressure
9) Painless vaginal bleeding
10) Snowflake or snowstorm pattern / grape-like appearance but no fetal growth visible
In an H-mole pregnancy, hCG levels are as high as
1-2 million mIU/mL or even higher.
Why is the uterus larger than expected for gestational age in an h-mole pregnancy
Due to rapid proliferation of abnormal celss
What are symptoms of hyperthyroidism
- tachycardia
- sweating
- tremors
hCG mimics TSH functions
Diagnostic procedures for Molar Pregnancy
- Ultrasound
- hCG blood test
- Histopathology
- X-ray
Classic sign of molar pregnancy
Snowstorm / cluster of grapes appearance in an ultrasound
This is done in order to rule out metastatic lesions since H-mole may lead to choriocarcinoma which can metastasize to the lungs.
X-RAY
Therapeutic management for H-Mole
- D& C or Suction Curettage
- Monitoring hCG levels
- Chemotherapy (If needed)
This is done to evacuate the abnormal molar tissues to prevent heavy bleeding & reduce risk of cancer.
D & C or Suction Curettage
How long is post-evacutaion monitoring hCG levels done?
Weekly until undetectable, then monthly for 6-12 months
Reasosn for monitoring hCG levels post evacuation
- Check if level is declining
- Rule out gestational trophoblastic neoplasia
What does it mean if hCG levels are still increasing post evacuation?
Would suggest malignancy (choriocarcinoma)
Commonly used chemo drugs
Methotrexate or Dactinomycin
Used to effectively treat the malignancy
Methotrexate
This chemo drug is added after if metastasis occurs.
Dactinomycin
Why avoid pregnancy for 1 yr after diagnosis & treatment of malignancy
Prevent interference with hCG monitoring
Woman should use oral contraceptives
