Molar Pregnancy - Finals obstetrics revision notes-Medicine, Lecture notes of Medicine

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3/12/25, 1:54 PM about:blank Molar Pregnancy - Finals obstetrics revision notes Molar Pregnancy = Trophoblastic tissue proliferates in a more aggressive way than normal. hCG is excreted in excess. More common in extremes of matemal age 2x as common in Asian women Hydatidiform Mole = Localized, non-invasive tumour which grows like a pregnancy inside the os Divided into partial and complete mole. O intirely paternal in origin, usually one sperm fertilizes an empty oocyte and undergoes mitosis, Results in diploid tissue, usually 46XX. There is no foetal tissue, merely a proliferation of swollen chorionic villi = triploid, derived from two sperms entering one oocyte. New cell has 3 sets of chromosomes. Some foetal material may form. Invasive Mole = Malignant tissue, invasion has occurred in uterus. Choriocarcinoma = Metastasis, Placental Site Trophoblastic Tumour (PSTT) = Presents 3 years after index pregnancy. Clinical F 0 Large uterus Early pre-eclampsia and hyperthyroidism Heavy vaginal bleeding Severe vomiting (hyperemesis) Investigations. USS shows snowstorm appearance of swollen villi with complete moles Biopsy to confirm diagnosis histologically Serum hCG will be very high Thyrotoxicosis — heG mimics TSH, so there will be high T3/T4 and low TSH Management ‘Trophoblastic tissue is removed by suction curettage Serum hCG is taken as persistent rising levels suggest malignancy All patients have to be registered with one of the 3 centres in the UK to have guided management and follow up Pregnancy is avoided until after completion of the surveillance period 12