Molar Pregnancy

Hydatidiform Mole – Causes, Pathology, Diagnosis & Complication

What Is Hydatidiform Mole or Molar Pregnancy?

A Hydatidiform Mole or molar pregnancy is a pregnancy that is characterized by products of conception that do not develop into an embryo after fertilization, but a proliferation of villi chorialis accompanied by hydropic degeneration. Uterus softened and grown more rapidly than normal gestational age, no found presence of fetal and uterine cavity filled only by the tissue that resemble grapes.

Chorionic tufts growing form of multiple small bubbles that contain a lot of liquid so as to resemble grapes or eyelets pregnant so often called grapes or fish eye pregnant. These abnormalities are benign trophoblastic neoplasms.

Causes of Molar Pregnancy

The exact cause of hydatidiform mole is unknown. There are a couple factors causing this pregnancy, include :

  1. Ovum: pathological ovum had to die, but too late be taken out.
  2. Imunoselection of trophoblast.
  3. State of low socio-economic.
  4. High parity.
  5. Protein deficiency.
  6. Viral infection and chromosomal factors is not clear yet.

Pathology of molar pregnancy

Chorionic tufts growing double and a fluid containing small cysts that resemble grapes. Normally in it does not contain an embryo. In histopathological, sometimes found in placental tissue mole with a normal fetus. In addition, there can be multiple molar pregnancy, namely the fetus grows and the other into a hydatidiform mole. Bubble molar amount varies, ranging from small to more than 1 cm in diameter. Partial mole known if the fetus found and mole bubbles.

In microscopic, visible triad that includes :

  1. Proliferation of trophoblast.
  2. Hydropic degeneration of the stroma and villi swollen.
  3. Late or loss of blood vessels and stroma.

Langans cells looked like prolidral cells with bright nuclei and the presence of gigantic syncytial cell. In the case of moles, we have encountered many ovaries with multiple lutein cysts with diameter of 10 cm or more. Lutein cysts will gradually shrink, then disappear after hydatidiform mole healed.

Diagnosis and Symptoms

  1. History / complaint
    • There are early pregnancy symptoms that are sometimes more real than ordinary pregnancy.
    • Sometimes there is a sign of toxemia of pregnancy.
    • There is a little or a lot of bleeding, irregular, dark or brown color look like salad seasoning.
    • Enlargement of the uterus incompatible with large gestational age with older pregnancies should be.
    • The out of tissue that resemble grapes or molar face (not always available), which is a definite diagnosis.
  2. Inspection
    • Face and sometimes looks pale yellowish body, which is called the molar face.
    • If the mole is already out bubbles can be seen clearly.
  3. Palpation
    • Enlarged uterus incompatible with her pregnancy, feels mushy.
    • There is a palpable fetal parts and ballottement, also fetal movement.
    • There is a harmonica phenomenon, namely blood and bubbles mole out and fundus down, then up again due to the accumulation of new blood.
  4. Auscultation
    • It does not sound fetal heart rate.
    • There was a loud and distinctive sound.
  5. Pregnancy Reaction: HCG levels high because the biological and immunological test will be positive after dilution.
  6. Exams and Tests
    • Make sure the size of the uterus, the uterus was soft, no fetus partS, there is bleeding and tissue in the cervical canal and vagina as well as the evaluation of the state of the cervix.
    • Sonde Test: sonde inserted slowly and carefully into the cervical canal and uterine cavity. If no resistances, as well as the sonde is pulled slightly rotated. If no resistances, the possibility of moles.
  7. X-ray Abdominal: no fetal bones visible (at 3-4 months of pregnancy ).
  8. Arteriogram for pelvic.
  9. Ultrasound mole blizzard shadow will appear and no fetus visible.

Differential Diagnosis

  1. Multiple pregnancy.
  2. Hydramnios.
  3. Abortion.

Complication

  1. Severe bleeding, shock, which if not treated can be fatal.
  2. Repeated bleeding can lead to anemia.
  3. Secondary infection.
  4. Perforation due to malignancy and action.
  5. Become malignant in approximately 18-20 % of cases, which would be a molar destruens or choriocarcinoma.

[Image Credit : Lunar Caustic]

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