Gestational trophoblastic disease early detection, diagnosis, and. Gestational trophoblastic disease diagnosis and workup. To learn about the aetiology and diagnosis of molar pregnancy. A urine pregnancy test is commonly used to detect pregnancy and is based on finding intact. The management of molar pregnancy donald peter goldstein, m. The paternal allele at each str locus is roughly twice the height of the maternal allele, indicating a triploid genotype with 2 homozygous alleles coming from one sperm. Molar pregnancy does not result in viable fetus, early detection and treatment is essential for positive outcome. Diagnosis and treatment of gestational trophoblastic.
The ultrasound diagnosis of a partial molar pregnancy is more complex. Webmd explains what the symptoms are and how its diagnosed and treated. Ultrasonography has replaced all other noninvasive means of establishing the diagnosis 4,8. The correct diagnosis is a monospermic partial hydatidiform mole. After the diagnosis of a molar pregnancygtd it is important to have follow. Diagnosis can be difficult, particularly in early pregnancy loss, when many of the characteristic features of molar pregnancies are illdefined in the villi due to poor tissue differentiation. Also called gestational trophoblastic disease gtd, hydatidiform mole or simply referred to as a mole, this is a rare condition occurring in 1 out of every 1,000 pregnancies. Diagnosis of complete molar pregnancy by microsatellites in archival material article pdf available in journal of clinical pathology 464. A molar pregnancy is a gestational trophoblastic disease which grows into a mass in the uterus that has swollen chorionic villi. Sonographic diagnosis of partial versus complete molar. Molar pregnancy is a rare complication that requires early treatment. There is an increasing risk for complete moles with advancing maternal age. The diagnosis of molar pregnancy was made on ultrasonography in 12 57% cases, was second in the differential diagnosis of one 4.
In most cases, molar pregnancy is discovered when a miscarriage occurs. These more invasive forms of gestational trophoblastic disease gtd sometimes develop after a complete mole has been removed. Patient summary gestational trophoblastic disease gtd is the name given to some uncommon tumours of placental tissue. Most molar pregnancies are diagnosed at the first ultrasound scan then confirmed by a laboratory analysis of the pregnancy tissue. There are two types of molar pregnancy partial and complete. Molar pregnancy diagnosis and treatment mayo clinic. A molar pregnancy is a rare complication that happens when tissue inside the uterus becomes a mass or tumor.
When a diagnosis of complete or partial molar pregnancy is suspected, the patient should be evaluated for the presence of medical complications, including anemia, preeclampsia and hyperthyroidism. Differential diagnosis and management of molar pregnancy. Biochemistry and measurement in pregnancy and disease view in chinese. The diagnosis of choriocarcinoma in molar pregnancies. The most of cases present as missed pregnancy during ultrasonic examination 10. The diagnosis of molar pregnancy can usually be confirmed by ultrasound after which the molar tissue is removed by d and c or suction evacuation of the uterus. Less expensive downloadable pdf versions are also available. Sometimes a molar pregnancy is diagnosed when you go for your usual pregnancy ultrasound scan. These include products of conception specimens with abnormal villous morphology, early nonmolar specimens with prominent trophoblastic hyperplasia, hydropic abortuses, and androgenetic. Blood and urine tests may be used to detect abnormally high levels of human chorionic gonadotropin hcg. It is sometimes detected when you have an early pregnancy ultrasound. The molar pregnancy is found when the uterus is scraped during a suction.
Cases with no prior clinical history and a morphological diagnosis of a molar pregnancy would be better suited to initial screening by. When it occurs earlier in pregnancy like during the first or early second trimester, it can be a sign of a complete molar pregnancy. Usually pstt presents with gynaecologic symptoms, about present with metastases, and some patients present with hyperprolactinaemia or nephrotic syndrome. Do you have pregnancy symptoms with a molar pregnancy. Gestational trophoblastic disease early detection, diagnosis.
Partial hydatidiform moles are formed by a dispermic fertilization of a normal ovum leading to a triploid pattern, and are clinically distinguished from complete molar pregnancies because affected patients have a uterus that is often small for gestational age. A partial one is when both the placenta and embryo fertilized egg are abnormal. It happens when a mans sperm joins the womans egg, but normal conception of a. Subsequent pregnancy experience in patients with molar pregnancy and gestational trophoblastic tumor. Histopathological examinations of products of conception are presently gold standard for diagnosis of gestational molar pregnancy. A molar pregnancy also known as hydatidiform mole is a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta. Human chorionic gonadotropin followup in patients with molar pregnancy. This case, particularly given the atypical clinical presentation for a partial molar pregnancy, highlights the importance of ultrasound in pregnancy, and the utility of bedside ultrasound in the evaluation of the etiology of vaginal bleeding in the early pregnant. This condition may also be called a hydatidiform mole or gestational trophoblastic tumour. Approximately 20% of women with a complete mole develop a trophoblastic malignancy.
It happens when a mans sperm joins the womans egg, but normal conception of a baby does not take place. Molar pregnancy is part of a group of diseases classified as gestational trophoblastic disease gtd, which originate in the placenta and have the potential to locally invade the uterus and metastasize. Surveil lance after evacuation of a molar pregnancy whether complete or a partial mole consists of regular evaluation. Feb 27, 2019 a molar pregnancy is often completely asymptomatic, and the diagnosis is made only when the first pregnancy scan routinely scheduled at 10 to 14 weeks reveals the problem.
Negative urine pregnancy test in a molar pregnancy. A complete hydatidiform mole is also called a complete molar pregnancy. Cytogenetic and molecular diagnosis in gestational disorders. Because of early diagnosis and appropriate treatment, the current mortality rate from hydatidiform mole is essentially zero. Preeclampsia might cause problems such as high blood pressure, headache, exaggerated reflexes, swelling in the hands or feet, and too much protein. While hydatidiform pregnancies are relatively rare, eps should be aware of the clinical and sonographic features of these diseases. Cytogenetic and molecular diagnosis in gestational disorders katherine geiersbach, m. The management of gestational trophoblastic disease rcog. Since that time, hm also referred to as molar pregnancy or mole has been of clinical and research interest. After treatment with chemo, you can still get pregnant again. Histologic analysis of the dilation and curettage specimen showed immature chorionic villi without vesicles or evidence of molar pregnancy.
Management of gestational trophoblastic disease cgyn 31 3 1. On the basis of the us appearance, the diagnosis of molar pregnancy was suggested. 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. Cases with no prior clinical history and a morphological diagnosis of a molar pregnancy would be better suited to initial screening by p57 staining and fish ploidy testing. Preeclampsia toxic pregnancy some symptoms that are seen with complete moles, such as frequent vomiting or an overactive thyroid gland, rarely, if ever, occur with partial moles. The cause of a molar pregnancy is unknown, however, the following increase your risk. Garner ei, lipson e, bernstein mr, goldstein dp, berkowitz rs. This does not develop into an embryo, yet the symptoms of this growth are similar to that of pregnancy. Ultrasound uses sound waves to show an image of the contents within the uterus. Molar pregnancy is a situation in which a nonviable fertilized egg does not complete its term and becomes an abnormal growth inside the uterus, instead. Mar 02, 2018 if a woman is known to have had a molar pregnancy, her followup is coordinated by our uk regional gtd units and she has an increased risk of a recurrent mole in future pregnancies, particularly after a cm. Choriocarcinoma is a rare type of tumor that happens in women during pregnancy. Most cases of molar pregnancy are diagnosed after what appears to be a.
Subsequent pregnancy outcomes after complete and partial molar pregnancy, recurrent molar pregnancy, and gestational trophoblastic neoplasia. Oct 23, 2015 approximately 1015% of molar pregnancies are invasive, causing hemorrhaging and other complications, with 23% developing into a choriocarcinoma 1, 4. Clinical diagnosis of molar pregnancy was suspected in patients, but only 69. A molar pregnancy is very uncommon affecting around 1 in 1,200 pregnancies. Prenatal diagnosis 32, 17 epub 8 nov 2012 distribution of abnormalities by mechanism. Sadly, a molar pregnancy is a type of pregnancy loss as the baby either does not. An information guide for patients diagnosed with partial. Feb 16, 2018 a study by vargas et al indicated that in women who have had molar pregnancies, the outcomes of subsequent pregnancies are similar to pregnancy outcomes in the general population. Diagnosis of molar pregnancy thailand medical news. Symptoms may include pv bleeding, pelvic mass, or symptoms from distant metastases such as liver, lung and brain metastases. A molar pregnancy occurs when the fertilisation of the egg by the sperm goes wrong and leads to the growth of abnormal cells or clusters of water filled sacs inside the womb.
As a booklet, it provides basic information about a molar pregnancy and the required. Molar pregnancy clinic guide for clinicians gestational trophoblastic. Feb 16, 2018 feltmate cm, batorfi j, fulop v, et al. The reported incidence of choriocarcinoma ranges from 1 in 40 000 pregnancies in north america and europe, to 9. Transvaginal and transabdominal ultrasound are also commonly used diagnostic tools, which enable doctors to see signs of molar pregnancy. Diagnosis and treatment of gestational trophoblastic disease. Dec 14, 2017 a molar pregnancy also known as hydatidiform mole is a rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta. There are two types of molar pregnancy, complete molar pregnancy and partial molar pregnancy. A molar pregnancy is also called a hydatidiform mole pregnancy. Download fulltext pdf diagnosis of molar pregnancy and persistent trophoblastic disease by flow cytometry article pdf available in journal of clinical pathology 406.
It is therefore not surprising that many women who have a molar pregnancy feel overwhelmed at first. An information guide for patients diagnosed with partial hydatidiform mole phm. A molar pregnancy is usually suspected when a women develops bleeding in early pregnancy. An elevated hcg level at the time of ultrasonographic examination may help to distinguish an early com plete mole from a missed abortion. This information is for patients who have been diagnosed with a molar pregnancy. The diagnosis of a molar pregnancy might be suspected based on a number of clinical features. Instead due to an abnormality at conception, the cells that form the placenta also called the afterbirth overdevelop. In a molar pregnancy the fertilisation of the egg by the sperm goes wrong and creates abnormal cells or clusters of water filled sacs inside the womb. 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. Signs and symptoms of gestational trophoblastic disease. Molar pregnancy suction evacuation of molar pregnancy should be carried out by an experienced gynecologist, especially if the uterus is larger than. Diagnosis and management of gestational trophoblastic disease.
It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Once the diagnosis of molar pregnancy is suspected based on history, physical examination, hcg level, and ultrasound findings, the patient should be evaluated for the presence of medical complications anemia, preeclampsia, hyperthyroidism, which may need to be corrected. A molar pregnancy is an abnormality of the placenta, caused by a problem when the egg and sperm join together at fertilization. If you have a molar pregnancy, further testing will be done to determine the type of mole and the possibility of it having spread outside the uterus. Personal stories from diagnosis through recovery two collections of personal stories about dealing with the molar pregnancy experience, as well as information and references about the condition. What increases my risk for a complete molar pregnancy. Molar tissue is typically identified as a diffuse mixed echogenic pattern replacing the. Partial moles are often diagnosed after a woman has what is thought to be a miscarriage. May, 2019 an ultrasound of the pelvis typically can confirm a diagnosis of a molar pregnancy. Ultrasound examination is helpful in making a preevacuation diagnosis but the definitive diagnosis is made by. With a molar pregnancy, tissue in the uterus becomes an abnormal mass or tumor instead of a placenta. Molar pregnancy india pdf ppt case reports symptoms. Learn more about diagnosis and treatment of this type of pregnancy loss. Update on the diagnosis and management of gestational.
Other times, your doctor will prescribe blood tests and scans if you have symptoms. Pregnancy before the age of 15 and after the age of 40. Most cases of molar pregnancy are diagnosed in the first trimester by ultrasound or as early pregnancy losses. The risk of having a repeat molar pregnancy in this study was found to. Because women who have had one molar pregnancy are at increased risk, doctors can be especially careful in checking their future pregnancies with hcg tests. Molar pregnancy shows initial symptoms same as that of a normal pregnancy. Routine first trimester ultrasound examination can identify partial or complete molar pregnancy. Gestational trophoblastic disease gtd or molar pregnancy. Most cases of molar pregnancy are diagnosed in the first trimester by ultrasound or as early. A molar pregnancy is a gestational trophoblastic disease 1 which grows into a mass in the uterus that has swollen chorionic villi. A twin molar pregnancy is very rare, and includes the development of a normal fetus along with a molar pregnancy, because of the separate fertilization of two ova by two sperms symptoms and diagnosis a molar pregnancy is often completely asymptomatic, and the diagnosis is made only when the first pregnancy scan routinely scheduled at 10 to 14.
If a molar pregnancy is suspected before a miscarriage occurs, it can usually be detected by ultrasound. You may feel shocked and anxious by the unexpected diagnosis of a molar pregnancy in addition to grieving for your lost pregnancy. The differentiating symptoms develop gradually which can be diagnosed by the doctor as the formation of abnormal placental tissue, size of the uterus, vaginal discharge of grapelike cluster of cysts and hyperthyroidism. The differential diagnosis of hydatidiform moles includes a variety of nonmolar entities that can exhibit some features suggestive of a molar pregnancy. This condition is one of a group of conditions known as gestational trophoblastic tumours gtts. History of prior spontaneous abortion also appears to increase risk of a molar pregnancy both complete and partial 2 to 3fold compared to women without.
Most of the symptoms are due to very high levels of the pregnancy hormone hcg, so they can be very like the usual symptoms of pregnancy. This would provide information about recurrence risk for future pregnancies, and the risk of choriocarcinoma due to imprinting defects. The management of gestational trophoblastic disease. Some women dont have any obvious symptoms of molar pregnancy. An ultrasound of a complete molar pregnancy which can be detected as early as eight or nine weeks of pregnancy may show. The pathologic diagnosis of molar pregnancy, either partial or complete, depends on. Registering patients for hcg followup after molar pregnancy evacuation. To assess the prospective sonographic diagnosis of molar pregnancy and compare sonographic features of complete versus partial molar pregnancy. The study looked at 88 subsequent pregnancies in women with complete hydatidiform mole, as well as 357 pregnancies following partial hydatidiform mole and 667. Mar 15, 2020 molar pregnancy can involve the same stages of grief as other miscarriages, but like ectopic pregnancy another potentially dangerous condition, grieving from molar pregnancy can be both a relief that the condition was detected as well as grief for the loss of the expected baby. Diagnosis and management of gestational trophoblastic disease john l. Molar pregnancies are the commonest and are categorised as complete or partial, occurring in 1. Risk of a repeat molar pregnancy after one mole is approximately 1%, about 10 to 20 times the risk for the general population, while after two moles, the risk of a third mole is 15% to 20%. The abnormal tissue is not cancer, but may become cancer.
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