Molar Pregnancy

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Hydatidiform Mole

• Mamdoh Eskandar FRCSC

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Gestational trophoblastic Disease

• Molar pregnancy
• -Complete hydatiditform mole
• -Incomplete hydatiditform mole
• Choriocarcinoma
• Placental-site trophoblastic tumor

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Molar Pregnancy

• Complete mole
• - Fertilization an empty egg by one sperm.
• -All placental villa swollen.
• -Fetus, cord, amniotic membrane are absent.
• -Paternal chromosomes only. 46 XX.
• -diploidy

• Incomplete mole
• -fertilization of an egg by two sperms
• -some placental villa swollen
• Fetus, cord, amniotic membrane are present
• Paternal and maternal
• 69XXY
• -Triploid

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Molar Pregnancy

• Incidence and epidemiology
• -In USA 11000
• -In Asia 81000
• Risk factors for molar pregnancy
• -Extreme of age
• -Lower socioeconomic status
• -Race and ethnic origin
• -Blacks have lower incidence

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Molar Pregnancy

• Symptoms and signs of molar pregnancy
• -Abnormal bleeding in early pregnancy
• -Lower abdominal pain
• -Toxemia before 24 weeks of gestation
• -hyperemesis gravidarum

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Molar Pregnancy

• -Uterus large for dates
• -No fetal heart rate
• -Enlargement of the ovaries
• -Hyperthyroidism
• -Expulsion of swollen villi

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Molar Pregnancy

• Diagnosis
• -Ultrasound shows snowstorm-like appearance, no
  fetus, theca lutein cyst
• -Beta hCG in normal pregnancy the level is at it
  peak at around 14 weeks (100,000 mIU/ml)

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TORONTO, CANADA, 1998, SANT.JOS. HOS.
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Management

• Once the diagnosis is made evacuation of the
  uterus should be done but prior to that
• hCG preevacuation.
• Chest x-ray.
• Correct anemia, toxemia, hyperthyroidism,
  pulmonary compromise.

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Follow up

• HCG weekly until normal for two values then
  monthly for one year.
• Repeat x- ray if HCG rises or plateau.
• Contraception for one year.
• Pelvic examination every 3 weeks for 3 months.

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Follow up

• Initiate chemotherapy if
• -HCG level is increasing or plateaus
• -Metastasis disease is present
• -HCG level is still elevated after 6 months of
  evacuation
• -HCG starts to rise after being undetectable

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FICO Classification System of GTT

• I. Confined to corpus uteri
• II. Metastases to vagina or pelvic organs
• III. Metastases to lungs
• IV. Distant metastases

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Prognostic Classification of GTT

• I. Nonmetastatic GTT
• II. Metastatic GTT disease outside the uterus.
• Good prognosis
• Disease present less than 4 months
• Pretreatment HCG is less than 40,000
• No prior chemothreapy
• No metastatic to the liver or the brain
• Poor prognosis
• the opposite of good prognosis

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Thank you!