In what % of patients with hydatidiform mole height of uterus is more than expected for the period of amenorrrhea?
Ans. d (70%). (Ref. Dutta, Obstetrics, 5th ed., 206)HYDATIDIFORM MOLE/VESICULAR MOLE# Abnormal condition of ovum with partly degeneration & partly hyperplastic changes in young chorionic villi.# It is benign neoplasia of chorion with malignant potential.# Highest incidence in Philippines (Southeast Asia).# In India 1 in 400.# Can be complete or incomplete.# Complete moles have 46XX karyotype, molar chromosomes derived entirely from father (androgenous).# Vesicle fluid is interstitial fluid rich in HCQ# There is no trace of embryo or amniotic sac.# Vaginal bleeding commonest presentation (90%)# Expulsion of grape-like vesicles per vaginum is diagnostic.# Features of pre-eclampsia present in about 50%.# Size of uterus more than expected for period of ammenorrhea in 70%, corresponds with period of ammenorrhea in 20% & smaller in 10%.# Unilateral or bilateral enlargement of ovary# "Theca lutein Cyst" in 25-50% of cases.# USG - 'Snow storm' appearance.# HCG in urine between 1 in 200 to 1 in 500 beyond 100 days highly suggestive.# There is 4-5 times higher risk of recurrence in future pregnancy.# In-patient with mole in process of expulsion suction evacuation is best treatment.# In patients with inert uterus, suction evacuation with oxytocin drip supplement is preferred treatment.# Indications for hysterectomy:- Patient over 35 years of age.- Patient completed family irrespective of age# Preferred time for curettage after vaginal evacuation 5-7days.FeaturePartial MoleComplete MoleKaryotypeUsually 69,XXX or 69,XXY46,XX or 46,XYPathologyEmbryo-fetusOften presentAbsentAmnion, fetal red blood cellsOften presentAbsentVillous edemaVariable, focalDiffuseTrophoblasticVariable, focal, slight to moderateVariable, slight to severeClinical presentationUterine sizeSmall for dates50% large for datesTheca-iutein cystsRare25-30%Medical complicationsRareFrequentGestational trophoblastic neoplasia<5-10%20%
10%
30%
50%
70%
Miscellaneous (Gynae)