Molar Pregnancy

Molar Pregnancy
Definition and Etiology
• Hydatidiform mole is a pregnancy characterized by vesicular
swelling of placental villi and usually the absence of an intact
fetus.
• The etiology -- unclear, but appears to be due to abnormal
gametogenesis and fertilization
• Incidence-- 1 out of 500-600
Molar Pregnancy
Risk factors
1. Maternal age > 40 years
< 15 years
2. Paternal age > 45 years

3. Previous hydatidiform mole 1st: 1% , 2nd 15-28%

4. Vitamin A deficiency
5. Consanguinous marriages
6. Previous spontaneous abortion
7. More common in orients
Molar Pregnancy
Molar pregnancy - Complete
- Partial
Complete mole - Mass of tissue is completely made up of
abnormal cells
There is no fetus and nothing can be found at the time of the
first scan.
Partial mole - Mass may contain both these abnormal cells and
often a fetus that has severe defects.
Molar Pregnancy
History
Amenorrhoea
Vaginal bleeding
Excessive nausea & vomiting
Passage of vesicles
Examination
Uterine size> period of pregnancy
Soft boggy feel of uterus- with no fetal parts felt
Signs of anaemia
Molar Pregnancy
Diagnosis of hydatidiform mole

• Quantitative beta-HCG – value > 10,000mIU/ml

• Ultrasound is the standard criterion for identifying both complete

and partial molar pregnancies. The classic image is of a
“snowstorm” pattern
Molar Pregnancy
Signs and Symptoms of Complete
Hydatidiform Mole
• Vaginal bleeding
• Hyperemesis ( severe vomiting)
• Size inconsistent with gestational age( with no fetal heart
beating and fetal movement)
• Preeclampsia
• Theca lutein ovarian cysts
Molar Pregnancy
Signs and Symptoms of Partial Hydatidiform
Mole
• Vaginal bleeding
• Absence of fetal heart tones
• Uterine enlargement and preeclampsia is reported in only 3% of
patients.
• Theca lutein cysts, hyperemesis is rare.
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Differential diagnosis

• Abortion
• Multiple pregnancy
• Polyhydramnios
Molar Pregnancy
Treatment

Suction dilation and curettage :

• Complete evacuation of the uterus
• USG to confirm complete evacuation
• Serum β-HCG weekly till undetectable & monthly for 6 months
• Serum β- HCG expected to be undetectable by8-12 wks
• Advise contraception till then– condoms, OC pills after HCG negative
Molar Pregnancy
Indications for chemotherapy
 Serum B-HCG >20,000IU/L or urinary B-HCG > 30,000 IU/L 4
wks post evacuation
 Rising level of B- HCG anytime post evacuation
 Positive B-HCG levels 6 mths post evacuation
 Evidence of metastasis
 Persistant vaginal bleeding with +ve B- HCG
 Methotrexate is the drug used
RCOG Recommendations

1. Ultrasound has limited value in detecting partial molar pregnancies.

2. In twin pregnancies with a viable fetus and a molar pregnancy, the
pregnancy can be allowed to proceed.
3. Surgical evacuation of molar pregnancies is advisable.
4. Routine repeat evacuation after the diagnosis of a molar pregnancy is
not warranted.
5. Registration of any molar pregnancy is essential.
6. The combined oral contraceptive pill and hormone replacement therapy
are safe to use after hCG levels have reverted to normal.
7. Women should be advised not to conceive until the hCG level has been
normal for six months or follow-up has been completed (whichever is
the sooner).

Grade C recommendation