1.  Classification of gestational trophoplastic diseases  Etiology of hydatiform mole(H.mole)  Histopathology of H.mole  Clinical presentation  How to diagnose H. mole  Factors affecting prognosis  Management and follow up

2. Gestational trophoplastic diseases (GTD) (benign) Non invasive H. mole (malignant) invasive complete partial Non metastatic (invasive mole) Metastatic (choriocarcinoma)

3. H. mole I ncidence 1.Race or geographical area 2.Maternal age : > 40 & < 20 3.H/o previous mole 4.malnutrition, estrogen level, B group no evidence Etiology

4. Complete mole

5. Partial mole

9. Histopathology Complete mole *no fetus or membrane *oedematous villi *avascular *trophoplastic hypertrophy

12. Partial mole *there is fetus & membrane *focal changes *some vascularity *hypertrophy of syncytiotrphoplast only Clinical presentation *bleeding *hyperemesis *large for date uterus …… consistency? * P E *others…..thyrotoxicosis & DIC

13. Diagnosis U/S Snow storm

14. β HCG More than 500000 iu/L

15. Prognosis immediate Hemorrhage, sepsis, PE Molar metastasis 5% Chorio carcinoma Complete 10% Partial 0.5%

16. Management nvIestigations : full blood count,CXR, clotting screen & others Evacuation : *suction curettage *uterine stimulation (PG, oxytocin infusion) Hysterectomy:* sever bleeding *old age,complete family

18. ß-hCG is measured by radioimmunoassay every week till the test becomes negative for 3 successive weeks, then the test is repeated every month for one year. ß-hCG is measured by radioimmunoassay every week till the test becomes negative for 3 successive weeks, then the test is repeated every month for one year. Pregnancy is allowed if the test remains negative for one year.Pregnancy is allowed if the test remains negative for one year. Follow up

19. Contraception during follow up The combined pill is started when the beta-HCG becomes negative.The combined pill is started when the beta-HCG becomes negative. Till this happens, the condom can be used.Till this happens, the condom can be used. If the pill is used early the beta-HCG will take a longer time to become negative as oestrogen stimulates the growth of trophoplast.If the pill is used early the beta-HCG will take a longer time to become negative as oestrogen stimulates the growth of trophoplast.

20. The intrauterine device is not used because it may lead to irregular uterine bleeding which confuses the follow upThe intrauterine device is not used because it may lead to irregular uterine bleeding which confuses the follow up