abnormal nonviable fertilization that results in a nonviable gestation composed of abnormal placental tissue (eg, hyperplastic trophoblasts, hydropic trophoblastic villi).
complete hydatidiform mole→abnormal fertilization of an empty ovum by either 2 sperm or 1 whose genome then duplicates
The resulting gestation contains hypertrophic and hydropic trophoblastic villi that cause a marked elevation in the β-hCG level.
A hydatidiform mole is typically due to an abnormal fertilization, not a chromosomal abnormality, and parental karyotype is not indicated.
This abnormal fertilization leads to trophoblastic proliferation and hydropic villi with no associated fetal development.
| Clinical presentation | • Abnormal vaginal bleeding ± hydropic tissue • Uterine enlargement > gestational age • Abnormally elevated β-hCG levels (eg, >100,000 mIU/mL) • Theca lutein ovarian cysts • Hyperemesis gravidarum • Preeclampsia with severe features • Hyperthyroidism | | --- | --- | | Risk factors | • Extremes of maternal age (≤15 and >35) • Vitamin A deficiency • History of infertility • History of hydatidiform mole | | Diagnosis | • "Snowstorm" or “Swiss cheese” appearance on ultrasound • Quantitative serum β-hCG • Histologic evaluation of uterine contents | | Management | • Dilation & suction curettage • Hysterectomy is an alternate for patients who have completed childbearing. • Serial serum β-hCG post evacuation • Contraception for 6 months |
Trophoblastic Gestational tumors
Complete moles contain no fetal tissue, while partial moles contain some fetal tissue, but neither are viable, and no fetal heartbeat will be found on Doppler ultrasonography. Pelvic examination may demonstrate cystic molar clusters in the vagina, and laboratory evaluation will show abnormally increased β-hCG concentrations. Ultrasonography of the pelvis will also often show bilateral multilocular ovarian cysts (theca-lutein cysts) and abnormal echogenicity in the uterus (hydatidiform mole)
Additional ultrasound findings may include theca lutein cysts: large, bilateral, multilocular cysts that occur due to ovarian hyperstimulation.
Patients age >40 with HM are also at risk for more severe complications
As hCG (both α and β subunits) and TSH have a similar structure, elevations in hCG can mimic TSH and cause an increase in triiodothyronine (T3) and thyroxine (T4) concentrations. The markedly elevated hCG levels associated with HM can therefore cause overt hyperthyroidism(eg, hot flashes, tachycardia, smooth warm skin, low TSH)
Hydatidiform moles are treated with dilation and curettage or suction evacuation, followed by appropriate contraception and the sequential measurement of β-hCG to monitor for the development of malignant gestational trophoblastic diseases such as an invasive mole or choriocarcinoma. These malignant diseases are treated with chemotherapy.
<aside> 💡 During the surveillance period, contraception is prescribed as pregnancy would make it hard to determine the significance of a rising β-hCG level and to treat GTN. GTN rarely develops >6 months after suction curettage for a hydatidiform mole. Therefore, after 6 months of undetectable β-hCG levels, patients who are interested can attempt conception.
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heterogeneous anechoic mass of cystic structures, often referred to as a "Swiss cheese" or "snowstorm" pattern.
This appearance is due to cystic hydropic villi that create a heterogenous mass with anechoic spaces but no fetus or amniotic fluid.
Hydatidiform mole is a premalignant disease that can develop into gestational trophoblastic neoplasia (GTN), such as choriocarcinoma. uterine evacuation via suction curettage is indicated to remove all of the premalignant tissue and regardless of procedure done patients are followed with serial β-hCG levels
After suction curettage, β-hCG levels are followed weekly until undetectable; a plateau or increase in the β-hCG level is diagnostic of GTN. Once the β-hCG becomes undetectable, monthly monitoring of β-hCG levels continues for 6 months. During that time, a newly detectable β-hCG level is diagnostic for GTN.
It can take as long as 8 weeks after uterine evacuation for β-hCG levels to become undetectable
Ovarian theca lutein cysts develop due to ovarian hyperstimulation from markedly elevated β-hCG levels. and usually resolve spontaneously when Hydatidiform mole is tx.
Hyperemesis gravidarum and preeclampsia resolve after D & C
(Choice A) Misoprostol is contraindicated in the management of hydatidiform mole due to the high risk of incomplete uterine evacuation.
(Choice E) Because hydatidiform mole is a premalignant condition, conservative management is contraindicated due to increased risk for persistent GTN and/or complications of hydatidiform mole (eg, hyperemesis gravidarum, preeclampsia).
