Recurrent hydatidiform mole 1 recurrent hydatidiform mole 2. Hydatidiform moles should be treated by evacuating the uterus by uterine suction or by surgical curettage as soon as possible after diagnosis, in order to avoid the risks of choriocarcinoma. Because of early diagnosis and appropriate treatment, the current mortality rate from hydatidiform mole is essentially zero. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. The management of gestational trophoblastic disease. Gtn follows hydatidiform mole 60 per cent, previous miscarriageabortion 30 per cent, normal pregnancy or ectopic gestation 10 per cent. Serum hcg levels are obtained weekly until the levels are within reference range for 34 weeks.
Categorized as complete or partial based on gross characteristics, histologic findings, karyotype 3. This is not a normal pregnancy because a normal fetus does not form. Hydatidiform mole is an abnormal pregnancy characterized by varying degrees of trophoblastic proliferation both cytotrophoblast and syncytiotrophoblast and vesicular swelling of placental villi associated with an absent or abnormal fetusembryo. Partial hydatidiform mole presents to the physician as a mixture of normal villous placental trophoblastic tissue, hygromatous balls or cysts, and some fetal fragments, without an intact fetus. Hydatidiform mole hm is one of a group of diseases that develop from abnormal proliferation of trophoblast and are classified as gestational trophoblastic disease gtd. Hydatidiform mole symptoms, diagnosis, treatments and. Pdf successful primary treatment of a hydatidiform mole with. The two distinct types of hm, complete mole and partial mole, have different karyotypes, gross and microscopic histopathology, clinical presentations, and prognoses. It is the standard treatment for both complete and partial molar pregnancies. The incidence is higher toward the beginning and more toward the end of the childbearing period.
The most common form of gtd is hydatidiform mole, also known as molar pregnancy. May 15, 2010 hydatidiform vesicular mole it is a benign neoplasm of the chorionic villi. Estimates for the incidence of various forms of gestational trophoblastic disease vary. You are slightly more likely to need ongoing treatment if you had a complete hydatidiform mole. Experience, such as that found at regional gestational trophoblastic disease treatment centers, improves outcomes in the management of malignant gestational trophoblastic disease. Hydatidiform mole definition of hydatidiform mole by. Sometimes, during conception, a sperm fertilises an empty egg ovum. The benign hydatidiform mole partial and complete practically represents an associated pathology of the first trimester miscarriage. Molar pregnancy hydatidiform moles and choriocarcinoma symptoms and treatments see online here during pregnancy, it is possible for the tissue surrounding the embryo to degenerate. A hydatidiform mole is usually harmless, however it can keep growing and, if left untreated, can bury itself into the organs around it, including the uterus womb and even spread via the blood to other distant organs including the lungs, liver or brain. It is a type of gestational trophoblastic disease gtd. The tissue is a cluster of fluidfilled cysts that look like grapes. Epidemiology a complete hydatidiform mole is the commonest type of gestational trophoblastic dise.
The level of human chorionic gonadotropin in the blood is measured to determine whether the hydatidiform mole was completely removed. They typically arise from the abnormal fertilization of the ovum. This is an ovum not carrying any chromosomes or genetic material. Contemporary diagnosis of hydatidiform mole charles zaloudek, md nancy joseph, md, phd department of pathology university of california san francisco the presenters have no conflicts of interest to disclose gestational trophoblastic disease hydatidiform mole invasive mole choriocarcinoma placental site trophoblastic tumor pstt. Hydatidiform mole hm is a rare mass or growth that forms inside the womb uterus at the beginning of a pregnancy. A hydatidiform mole may be either complete or partial. Although an increasing proportion of moles are diagnosed as missed abortions from an early ultrasound examination in the absence of symptoms 8, most patients with complete moles have a clinical or ultrasonographic diagnosis of hydatidiform mole. Dec 14, 2017 in some cases, an invasive hydatidiform mole penetrates deep into the middle layer of the uterine wall, which causes vaginal bleeding. Prevention of postmolar gestational trophoblastic neoplasia using prophylactic single bolus dose of actinomycin d in highrisk hydatidiform mole. Guidelines from the royal college of obstetricians and gynecologists and. The complete hydatidiform mole is usually diploid and entirely androgenetic in origin. Stabilization of medical complications full operating room support in a hospital setting largebore intravenous iv access with possible central line monitoring. Pdf the controversy of hydatidiform mole treatment in women. Molar pregnancy, partial and complete hydatidiform mole presented by usmle ace, inc.
Gestational trophoblastic disease gtd is a group of disorders derived from a pregnancy. Because the embryo does not form or is malformed in molar pregnancies, and because there is a small risk of developing a. In the united states, hydatidiform moles are observed in approximately 1 in 600 therapeutic abortions and 1 in 1500 pregnancies. A hydatidiform mole hydatid mole, mola hydatidosa is a placental mass resulting from the proliferation of the trophoblast, with hydropic degeneration and avascularity of the chorionic villi. Aug 15, 2008 in the uk, most women with hydatidiform mole present with vaginal bleeding or suspected miscarriage in early pregnancy, which prompts pelvic ultrasonography, although in one observational study of 41 women with confirmed hydatidiform mole, 40% were asymptomatic, and the disorder was detected after routine ultrasonography in early pregnancy. Once treatment for the molar pregnancy is complete, your doctor may continue to monitor your hcg levels for six months to one year to make sure theres no remaining molar tissue. Hydatidiform mole complete or partial invasive mole choriocarcinoma placentalsite trophoblastic tumor epithelioid trophoblastic tumor hydatidiform mole the most common form of gestational trophoblastic disease gtd is a hydatidiform mole, also known as a molar pregnancy. The abnormal tissue is not cancer but may become cancer. All women with choriocarcinoma require treatment from the beginning. Molar pregnancy diagnosis and treatment mayo clinic. This grapelike mass forms inside of the uterus after fertilization instead of a. Complete hydatidiform mole radiology reference article. Hydatidiform moles are benign, whereas invasive moles and choriocarcinoma are malignant lesions with a tendency to metastasize to other organs, especially the lungs.
Doctors would send in a referral form on the family planning department for assistance. More than 90% of patients with partial moles have symptoms and ultrasound. Clinical presentation of complete hydatidiform mole and partial hydatidiform mole at a regional trophoblastic disease center in the united states over the past 2 decades. This means that hydatidiform mole, or a subtype of hydatidiform mole, affects less than 200,000 people in the us population. Pubmed is a searchable database of medical literature and lists journal articles that discuss recurrent hydatidiform mole. Gestational trophoblastic disease encompasses several disease processes that originate in the placenta. The hydatidiform mole may occur again if pregnancy occurs too soon after removal. Treatment is usually chemotherapy given by injection into a muscle or through a drip.
However, if hcg levels increase or plateau over several weeks, immediate evaluation and treatment for malignant postmolar gestational trophoblastic disease are indicated. Occasionally, the plateauing or increasing hcg levels. If you need treatment you will be given further information. It needs to be removed and most women can expect a full recovery. Gestational trophoblastic neoplasia gtn is a term used to describe gtd requiring chemotherapy. Diagnosis and management of hydatidiform mole and its. A hydatidiform mole or molar pregnancy is very uncommon affecting around 1 in 1,200 pregnancies.
Spontaneous resolution of hydatidiform mole hm has been reported. As a booklet, it provides basic information about a molar pregnancy and the required followup. The outcome for a normal pregnancy with a coexisting complete mole is poor, with approximately a 25% chance of achieving a live birth. It is generally accepted that the incidence is very high in developing countries. Types of gestational trophoblastic disease canadian. Feb 16, 2018 human chorionic gonadotropin and thyroid function in patients with hydatidiform mole. Management after evacuation of hydatidiform mole as long as hcg values are decreasing after molar evacuation, there is no role for chemotherapy. Sep 12, 2012 diagnosis and management of molarpregnancy treatment. Definition a hydatidiform mole is a relatively rare condition in which tissue around a fertilized egg that normally would have developed into the placenta instead develops as an abnormal cluster of cells. When it is confirmed that the patient has an h mole the doctor would perform suction curettage.
Because pregnancy hcg levels also increase during a normal pregnancy, your doctor may recommend you wait six to 12 months before trying to become pregnant again. About 10% of hydatidiform moles transform into one of the malignant forms of gestational trophoblastic disease, known as gestational trophoblastic neoplasia box 1. Hydatidiform mole approximately 20% of patients with primary hydatidiform mole develop persistent gtd invasive mole, choriocarcinoma, placental site trophoblastic tumor. Gestational trophoblastic diseases gtd include hydatidiform moles both complete and partial, invasive moles, and choriocarcinoma. Complete hydatidiform mole aftercare instructions what. Spontaneous resolution of hydatidiform mole hm has been reported since the first description of a molar pregnancy by hippocrates c. Nicolaes tulp 15931674, a dutch surgeon famously depicted in rembrandts painting the anatomy lesson of dr nicolaes tulp 1632, reported on the outcome of two of his patients in his observationes medicae 1672. Patients are followed up until their serum human chorionic gonadotrophin hcg level has fallen to an undetectable level. Hydatidiform mole or commonly known as molar pregnancy is one of the gestational trophoblastic disease gtd caused. A hydatidiform mole is a growing mass of tissue inside your womb uterus that will not develop into a baby. More detailed information about the symptoms, causes, and treatments of hydatidiform mole is available below symptoms of hydatidiform mole. A partial hydatidiform mole is a completely independent ailment to complete hydatidiform mole. Pdf hydatidiform mole molar pregnancy is the premalignant form of gestational trophoblastic neoplasia. It may also be diagnosed after a miscarriage, when the tissue that is collected or passed from the uterus is examined.
Invasive or metastatic moles may require chemotherapy and often respond. Hydatidiform mole is listed as a rare disease by the office of rare diseases ord of the national institutes of health nih. Molar pregnancy hydatidiform mole is defined as the premalignant form of gestational trophoblastic neoplasia. Methotrexate treatment for your hydatidiform mole july 2017 page 2 of 3 in a glass of warm water.
Webmd explains what the symptoms are and how its diagnosed and treated. Recurrent hydatidiform mole genetic and rare diseases. Gestational trophoblastic disease knowledge for medical. Hydatidiform mole as long as hcg values are decreasing after molar evacuation, there is no role for chemotherapy. The main types of gestational trophoblastic diseases are.
Persistent gtn can nearly always be successfully treated, most often with chemotherapy. When removal is complete, the level returns to normal, usually within 10 weeks, and remains normal, and no further treatment is needed. Your eyes may feel dry or irritated during treatment with methotrexate. Gtn most commonly follows hydatidiform mole as a persistently elevated hcg titre. A hydatidiform mole is the most common type of gtd. The symptoms of molar pregnancy, which may include vaginal bleeding, severe morning sickness, stomach cramps, and high blood pressure, typically begin around the 10th week of pregnancy. There is an increased risk of early fetal loss 40% and premature delivery 36%. Click on the link to view a sample search on this topic.
Approximately 20% of women with a complete mole develop a trophoblastic malignancy. The most common form of gestational trophoblastic disease gtd is a hydatidiform mole, also known as a molar pregnancy. It is of clinical and epidemiological interest because of its significant complication in pregnancy. Any woman for whom initial therapy for invasive mole has failed or who has a choriocarcinoma diagnosis should be referred to a physician or facility with training. This booklet provides general information for women who have been diagnosed with a molar pregnancy, also called a hydatidiform mole. A rare condition where an abnormal union between an egg and a sperm results in the formation of grapelike cysts instead of a baby. A complete hydatidiform mole chm is a type of molar pregnancy and falls at the benign end of the spectrum of gestational trophoblastic disease. The preferred treatment method of most hydatidiform moles is suction aspiration. Molar pregnancy hydatidiform moles and choriocarcinoma.
To find an obstetrician near you, use the find an obgyn tool on the american college of obstetricians and gynecologists website. Two types of hydatidiform mole, complete and partial, have been described. May 20, 2016 spontaneous resolution of hydatidiform mole hm has been reported since the first description of a molar pregnancy by hippocrates c. This term covers hydatidiform mole including complete and partial moles, invasive mole, gestational choriocarcinoma, and. Hydatidiform mole an overview sciencedirect topics. A hydatidiform mole may also be called a molar pregnancy. It may cause bleeding in early pregnancy and is usually picked up in an early pregnancy ultrasound scan. Hydatidiform moles occur in only one of every 1200 pregnancies in the united states. As long as the hcg levels are falling intervention is not needed. Normal levels are usually reached within 812 weeks after evacuation of the hydatidiform mole. This study was to determine the incidence, risk factors. A complete hydatidiform mole happens when cells turn into abnormal tissue in the uterus. Lubricating eye drops can be used and are available from your local pharmacy without a prescription.
Gtn most commonly follows hydatidiform mole as a persistently elevated hcg. Molar pregnancy is an abnormal form of pregnancy in which a nonviable fertilized egg implants in the uterus and will fail to come to term. Levels should consistently drop and should never increase. Such signs and symptoms include anemia, hyperemesis gravidarum, hyperthyroidism, respiratory failure, and preeclampsia doppler flow studies can also be used to evaluate the response to chemotherapy. Diagnosis and treatment of gestational trophoblastic disease. After the management of patients with hydatidiform mole, they are required to have a birth control method in the next 6 12 months for accurate monitoring of their hcg level. It is usually a noncancerous tumour, but there is a chance that it can persist after removal and spread. Such degeneration typically manifests itself in hydatidiform moles and choriocarcinoma. Another treatment option is removal of the uterus hysterectomy. The management of gestational trophoblastic disease rcog. The incidence of preeclampsia is variable, with rates as high as 20% reported. About gestational trophoblastic disease what is gestational. It does not contain all the information you will need to know about a molar pregnancy. Hydatidiform mole classification partial and complete hydatidiform moles are distinct disease processes with characteristic cytogenetic, histologic.
The evidence is based on published studiesmostly retrospective case seriesand expert opinion. Clinicians need to be aware of the symptoms and signs of molar pregnancy. Molar pregnancy is a condition in which the placenta does not develop properly. Approximately 20% of patients will develop malignant sequelae requiring administration of chemotherapy after evacuation of hydatidiform moles. A molar pregnancy is a rare complication that happens when tissue inside the uterus becomes a mass or tumor. Read more about symptoms, diagnosis, treatment, complications, causes and. Hydatidiform mole genetic and rare diseases information. Hydatidiform mole symptoms, diagnosis, treatments and causes. A hydatidiform mole is sometimes detected when you have an early pregnancy ultrasound. Hydatidiform mole molar pregnancy is the premalignant form of gestational trophoblastic neoplasia. Talk to your doctor about what treatment is best for you.
It is made up of villi that have become swollen with fluid. Diagnosis and treatment of gestational trophoblastic. Hydatidiform mole hm occurred in 1 in 452 deliveries and. The accuracy of first trimester ultrasound in the diagnosis of hydatidiform mole. Nov 01, 2016 a hydatidiform mole is a growing mass of tissue inside the womb uterus that will not develop into a baby.