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11.4 hydatidiform mole

HYDATIDFORM MOLE FOR GNM,ANM,MSC STUDENTS

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11.4 hydatidiform mole

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  1. HYDATIDIFORM MOLE MRS. AYMAN FATIMA

  2. DEFINITION • It is an abnormal condition of the placenta where there are partly degenerative and partly proliferative changes in the young chorionic villi. • It is principally a disease of the chorion.

  3. ETIOLOGY • Teenage pregnancies • Over 35 years of age • Faulty nutrition • Disturbed maternal immune mechanism • Cytogenic abnormality like 45 X • h/o prior hydatidiform mole

  4. CLINICAL FEATURES SYMPTOMS • Vaginal bleeding • Varying degree of lower abdominal pain due to over-distention of uterus, concealed hemorrhage. • Expulsion of grape like vesicles per vaginum. • Constitutional symptoms • Patient becomes sick without any apparent reason • Vomiting of pregnancy becomes excessive. • Breathlessness due to pulmonary embolism of the trophoblastic cells • Thyrotoxic features of tremors or tachycardia

  5. SIGNS • Features suggestive of early month of pregnancy • Patient looks more ill than she is accounted for. • Pallor • Features of pre eclampsia (hypertension, proteinuria and edema).

  6. Vaginal examination • Internal ballotment • Unilateral or bilateral enlargement of ovary • Finding vesicles in vaginal discharge is pathognomonic of hydatidiform mole. • Open cervical os – blood clots or vesicles may be felt.

  7. investigations • Full blood count, ABO and Rh grouping • Hepatic, renal and thyroid function tests • Sonography :- “ SNOW STORM” appearance. • Quantitative estimation of chorionic gonadotrophin- increasing value of serum hCG. • Straight X-ray abdomen - > 16 weeks- negative fetal shadow • CT and MRI – not recommended.

  8. COMPLICATIONS IMMEDIATE:- • Hemorrhage and shock • Sepsis • Perforation of the uterus • Pre-eclampsia • Acute pulmonary insufficiency • Coagulation failure LATE:- • Choriocarcinoma

  9. management PRINCIPLES:- • Supportive therapy to restore the blood loss and to prevent infection. • To evacuate the uterus as soon as the diagnosis is made. • Regular follow up for early detection of persistent trophoblastic disease.

  10. management • Group 1- the mole is in process of expulsion. • Group II – the uterus remains inert.

  11. Management of group I • Start a IV ringer solution • Arrangement is made for blood transfusion. • Suction evacuation is the best. Inj methergine 0.2 mg IM is given.

  12. Management of group ii • Blood should be kept ready • Evacuation of the uterus is to be done as soon as the diagnosis is made. • cervix is favorable – suction evacuation after infusion with oxytocin. It is done under diazepam sedation. • Cervix is tubular and closed – dilatation by laminaria tent followed by suction and evacuation.

  13. Management of group ii • Hysterotomy :- profuse vaginal bleeding • Hysterectomy:- patient over age of 35 • Patients completed the family irrespective of age.

  14. Management of group ii • Prophylactic chemotherapy:- methotrexate • Routine follow up is mandatory for all cases for at least 6 month.

  15. THANK YOU

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