Trophoblastic Disorders

Question 1

What is a molar pregnancy?

Answer 1

A hydatiform mole is a tumour that grows as if it were a pregnancy within the uterus (but instead it is an abomination spawned from the depths of hell).

There are two types: partial and complete

Question 2

What is a partial mole?

Answer 2

This occurs when two sperm cells fertilise a normal egg at the same time. The new cell has 3 sets of chromosomes instead of 2.

The cell then divides and becomes a partial mole - some foetal tissue may remain

Question 3

What is a complete mole?

Answer 3

This occurs when two sperm cells fertilise an empty egg at the same time. The egg contains no genetic material.

The cell will divide but no foetal material will be present.

Question 4

How do molar pregnancies present?

Answer 4

Initially, like a normal pregnancy. Signs that might indicate a molar pregnancy include:

• vaginal bleeding
• Extremely severe morning sickness
• Abnormally high HCG
• Increased uterine enlargement
• Thyrotoxicosis as HCG can mimic TSH (leading to excessive T3 and T4)

Question 5

What will molar pregnancies show on USS?

Answer 5

‘Snowstorm appearance’

- due to complex, vesicular intrauterine mass containing ‘grape-like’ cysts

Question 6

What is the management of a molar pregnancy?

Answer 6

Complete uterine evacuation and removal of the mole. Tissue is sent for histological examination to confirm.

All patients referred to regional gestational trophoblastic disease centre (nearest to NUH is Sheffield)

Question 7

What are the complications of a molar pregnancy?

Answer 7

The abject horror that is choriocarcinoma

The mole metastasises and spreads to distal sites such as the lungs

Systemic chemotherapy is then needed to clear it