Empowering Women's Health: Insights from a Gynecologist
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– Molar pregnancy, also known as HM or malignant hydatidiform mole, occurs due to abnormal fertilization of the egg.
– It results in an abnormal fetus and normal growth of the placenta with little or no fetal tissue growth.
– The placental tissue forms a mass in the uterus with a grape-like appearance on ultrasound, containing small cysts.
– Older women have a higher chance of developing a molar pregnancy.
– A history of molar pregnancy in earlier years is also a risk factor.
– There are two types of molar pregnancy: partial molar pregnancy, where there is an abnormal placenta and some fetal development, and complete molar pregnancy, where there is an abnormal placenta and no fetus.
– There is no known prevention for the formation of these masses.
– Mortality rate from hydatidiform mole is essentially zero due to early diagnosis and appropriate treatment.
– Approximately 20% of women with a complete mole develop a trophoblastic malignancy, which is almost 100% curable.
– Risk factors for malignant disease include advanced maternal age, high levels of hCG (>100,000 mIU/mL), eclampsia, hyperthyroidism, and bilateral theca lutein cysts.
– Predicting who will develop gestational trophoblastic neoplasia is difficult.
– Study suggests that outcomes of subsequent pregnancies in women who have had molar pregnancies are similar to those in the general population.
– Incidence of another molar pregnancy in women with a molar pregnancy is about 1.7%.
– Incidence of stillbirth in subsequent pregnancies in women with gestational trophoblastic neoplasia is 1.3%.
– Women with gestational trophoblastic neoplasia who conceive after chemotherapy have similar obstetric outcomes to those of the general population.
– Following a molar pregnancy, the risk of preterm birth is increased.
– Likelihood of large-for-gestational-age birth and stillbirth is greater if at least one birth occurs between the molar pregnancy and the index birth.
– Risk of adverse maternal outcomes is not increased following molar pregnancy.
– Malignancy is diagnosed in 15-20% of patients with a complete hydatidiform mole and 2-3% of partial moles.
– Lung metastases are found in 4-5% of patients.
– Perforation of the uterus during suction curettage is a potential complication, which may require laparoscopic guidance to complete the procedure.
– Hemorrhage is a common complication during the evacuation of a molar pregnancy, and intravenous oxytocin should be started at the beginning of suctioning.
– Other medications such as Methergine and Hemabate should also be available, and blood for possible transfusion should be readily available.
– Malignant trophoblastic disease develops in 20% of molar pregnancies, so quantitative hCG should be monitored regularly.
– Factors released by the molar tissue could trigger the coagulation cascade, leading to disseminated intravascular coagulopathy (DIC).
– Acute respiratory insufficiency can also occur due to trophoblastic embolism.
– The greatest risk factor for this complication is a larger uterus size compared to the expected gestational age.
– Choriocarcinoma
– Gestational choriocarcinoma
– Gestational trophoblastic disease
– Testicular cancer
– Chemotherapy
– Survival rates
– Vaginal bleeding
– Infections
– Pelvic cramps
– Fever
– Swelling around the stomach
– Lungs
– Coughing up blood
– Chest pain
– Breathing difficulties
– Human chorionic gonadotropin (hCG) hormone levels
– Imaging tests (ultrasounds, X-rays, MRI scans)
– Chorioadenoma
– Spinal fluid sample
– Lumbar puncture
– Radiation therapy
– Surgery
– Hysterectomy
– Recurrence
– Blood tests
– Pregnancy loss
– Menopause
– Colon cancer
– Breast cancer
– Normal, healthy pregnancy
– Medical help
– A hydatidiform mole, or molar pregnancy, is a rare condition affecting approximately 1 in 1,200 pregnancies.
– It is typically detected in early pregnancy and can be identified through ultrasound or examination of tissue after a miscarriage.
– In a molar pregnancy, there is abnormal and rapid growth of part or all of the placenta, resulting in a larger than normal size and the presence of fluid-filled cysts.
– Two types of molar pregnancy include complete molar pregnancy, in which a fetus does not develop, and partial molar pregnancy, in which a fetus develops but is abnormal and cannot survive beyond three months.
– Despite the abnormal pregnancy, women may still experience typical symptoms such as morning sickness or sore breasts due to the production of the pregnancy hormone hCG by the placenta.
– In some cases, the placenta can become malignant and develop into choriocarcinoma, a rare form of cancer that can spread to organs like the lungs, liver, and brain. Choriocarcinoma responds well to chemotherapy.
– Risk factors for molar pregnancy include age (under 18 or over 35), Asian or Mexican background, a diet low in carotene, and a history of previous molar pregnancy or other gestational trophoblastic tumor.
– Registries like the Gestational Trophoblastic Disease (GTD) Registry at the Royal Women’s Hospital are established to monitor and provide follow-up care for women who have had a molar pregnancy.
– Regular monitoring of hCG levels is necessary to detect any remaining molar cells that could grow and potentially spread to other organs. Testing involves urine and blood collection, and treatment may be required if hCG levels do not decrease.
– It is important to avoid getting pregnant again until discharged from the registry to prevent confusion between a new pregnancy and persistent trophoblastic disease. After discharge, attempting a new pregnancy is safe after having at least one normal period and using contraception during this time.
– Emotional healing after a molar pregnancy can take a longer time than physical healing from treatment, and seeking support from family, friends, and the GTD Registry team is recommended.