Molar Pregnancy😍

Molar Pregnancy/ Hydatidiform Mole (H Mole)

• Benign disease of trophoblast with malignant potential

• Features due to ↑ HCG:
• Hyperemesis gravidarum
• Thyrotoxicosis
• B/L theca lutein cysts
• HTN < 20 weeks

Grossly:

• Identified by grape-like vesicles (hydropic villi filled with water).

Microscopy:

• Shows big hydropic villi.

Molar Pregnancy Types

USG Finding:

• USG findings:
• Multiple Cystic Spaces in the uterus.
• No fetal parts.
• Snowstorm appearance
• d/t Hydropic degeneration of placenta
• Edematous villi
• B/L Theca Lutein Cyst
• d/t Increased Beta HCG

• Placentomegaly

Molar Pregnancy Management

• Primary Treatment:
• Suction evacuation
• followed by Sharp curettage
• Sample sent for HPE.

• Alternative (Age/Parity):
• If age >40 years + family complete:
• Total Abdominal Hysterectomy (TAH).

• Theca Lutein Cysts: 
• Spontaneously regress (No specific management required).

• Follow-up (b-hCG):
• Weekly b-hCG levels until 3 consecutive findings are Normal/undetectable.
• F/b Monthly b-hCG for 6 months 1 year
• Pregnancy is Contraindicated during follow-up;
• OCPs preferred.

Gestational Trophoblastic Neoplasia (GTN)

GTN Features and Management

• IM > CCA > PSTT > ETT

• HPE is not required to differentiate between GTN types.

• Mnemonic:
• Chori invade cheythal chemical ozhikkanam
• TT → hysTerectomy + chemoTherapy

GTN Signs & Symptoms

• Persistent bleeding.

• Persistent theca lutein cyst.

• Shock (Due to Invasive mole).

• Subinvolution of uterus.

• Metastasis: Lungs > vagina.

GTN Laboratory Investigations

Type of Chemotherapy Based on Stage and WHO Score :

• Mnemonic: 7 yr old (7-high risk) Emma (EMACO) Molkk (Molar prg) etomtop (Etoposide) actor (Actinomycin D) avan Cycle (Cyclophosphamide) vangi

• M/c mets → Lungs
• M/c chest X-ray finding
• Cannon ball appearance > Snow storm appearance.

WHO Scoring System