MOLAR PREGNANCY

Ayman Al-Talib*, MD, SSCOG, GOC

ABSTRACT

Hydatidform Mole comprises 90% of gestational trophoplastic disease (GTD) cases. It consists of complete mole (CM) and partial mole (PM). In CM the majority of cases are 46XX androgenetic karyotype with no fetus, while PM are ttriploid karyotype (69, XXY) in the majority of cases with an abnormal fetus. Familial recurrent hydatidiform mole: it is a rare autosomal recessive condition which runs in families. The chromosomes are biparental, unlike the usual androgenetic origin. Several risk factors have been evaluated; maternal age and previous molar pregnancy were the most common. The clinical presentation of CM has changed in the last 2 decades with vaginal bleeding as a common symptom due to earlier diagnosis by first trimester ultrasonography (USG). Most of CM moles are diagnosed in first trimester; a typical appearance of a complex echogenic intrauterine mass containing small cystic spaces is suggestive. Occasionally, cystic lesions are noted in placenta on USG of PM. USG detected both CM and PM before the evacuation in less than 60% of cases, so histological examination of product of conception is essential for the diagnosis. Suction evacuation is the standard treatment irrespective of uterine size. The serum hCG level is a sensitive indicator in follow up the disease process, including treatment response and detection of persistent GTD and relapse. Several risk factors are well known to increase the risk for GTD include: a preevacuation hCG level (> than 100,000 IU/L), Age >40 years, large for date uterine size and presence of thecan-lutein cyst (>6 cm).

Keywords: Molar pregnancy, Complete Mole, Partial Mole, GTD.