2. Hydatidiform Mole
Mamdoh Eskandar FRCSC

3. Gestational trophoblastic Disease
Molar pregnancy
-Complete hydatiditform mole
-Incomplete hydatiditform mole
Choriocarcinoma
Placental-site trophoblastic tumor

4. Molar Pregnancy Complete mole Incomplete mole
- Fertilization an empty egg by one sperm.
-All placental villa swollen.
-Fetus, cord, amniotic membrane are absent.
-Paternal chromosomes only. 46 XX.
-diploidy
Incomplete mole
-fertilization of an egg by two sperms
-some placental villa swollen
Fetus, cord, amniotic membrane are present
Paternal and maternal
69XXY
-Triploid

7. Molar Pregnancy Incidence and epidemiology:
-In USA 1:1000
-In Asia 8:1000
Risk factors for molar pregnancy:
-Extreme of age
-Lower socioeconomic status
-Race and ethnic origin
-Blacks have lower incidence

8. Molar Pregnancy Symptoms and signs of molar pregnancy
-Abnormal bleeding in early pregnancy
-Lower abdominal pain
-Toxemia before 24 weeks of gestation
-hyperemesis gravidarum

9. Molar Pregnancy -Uterus large for dates -No fetal heart rate
-Enlargement of the ovaries
-Hyperthyroidism
-Expulsion of swollen villi

10. Molar Pregnancy Diagnosis:
-Ultrasound shows snowstorm-like appearance, no fetus, theca lutein cyst
-Beta hCG in normal pregnancy the level is at it peak at around 14 weeks (100,000 mIU/ml)

11. TORONTO, CANADA, 1998, SANT.JOS. HOS.

13. Management
Once the diagnosis is made evacuation of the uterus should be done but prior to that:
hCG preevacuation.
Chest x-ray.
Correct: anemia, toxemia, hyperthyroidism, pulmonary compromise.

14. Follow up
HCG weekly until normal for two values then monthly for one year.
Repeat x- ray if HCG rises or plateau.
Contraception for one year.
Pelvic examination every 3 weeks for 3 months.

17. Follow up Initiate chemotherapy if:
-HCG level is increasing or plateaus
-Metastasis disease is present
-HCG level is still elevated after 6 months of evacuation
-HCG starts to rise after being undetectable

18. FICO Classification System of GTT
I. Confined to corpus uteri
II. Metastases to vagina or pelvic organs
III. Metastases to lungs
IV. Distant metastases

19. Prognostic Classification of GTT
I. Nonmetastatic GTT
II. Metastatic GTT: disease outside the uterus.
Good prognosis:
Disease present less than 4 months
Pretreatment HCG is less than 40,000
No prior chemothreapy
No metastatic to the liver or the brain
Poor prognosis:
the opposite of good prognosis

20. Thank you!