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Vesicular Mole

It is a benign neoplasm of the chorionic villi . Incidence:. 1:2000 pregnancies in United States and Europe. 1:200 in Asia. 10 times more in women over 45 years old.. The increasing use of ultrasound in early pregnancy has probably led to the earlier diagnosis of molar pregnancy. 1-Maternal age

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Vesicular Mole

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    1. Vesicular Mole

    5. What Is A Hydatidiform Mole? A hydatidiform mole is an abnormality of fertilization

    6. Differentiation Between Complete And Partial Mole

    8. There is trophoblastic proliferation, with mitotic activity affecting both syncytial and cytotrophoblastic layers. This causes excessive secretion of hCG,chorionic thyrotrophin and progesterone. . Pathology

    9. (hydropic) villi The uterus is distended by thin walled, translucent, grape-like vesicles of different sizes. Pathology

    10. There is no vasculature in the chorionic villi leads to early death and absorption of the embryo. Pathology

    11. High hCG causes: Pathology

    13. Symptoms and Signs Usually occur in first 20 ­ 24 weeks of gestation.

    14. GTD

    15. U/S evaluation. Complete Hydatidiform Mole

    16. The coexistence of a fetus with a complete hydatidiform mole is uncommon (in contrast to the partial hydatidiform mole), occurring in 1%-2% of cases .as a result of dizygotic twinning; thus, the fetus is chromosomally normal. but, fetal survival until term is unlikely because of the maternal complications of the mole itself Complete Hydatidiform Mole

    17. Complete Hydatidiform Mole

    18. the ultrasound diagnosis of a complete mole is often reliable, the diagnosis of a partial molar pregnancy is more complex. The finding of multiple cystic spaces in the placenta is suggestive of a partial molar pregnancy. * When there is diagnostic doubt about the possibility of a combined molar pregnancy with a viable fetus then ultrasound examination should be repeated before intervention. Partial Hydatidiform Mole

    19. In twin pregnancies with a viable fetus and a molar pregnancy, the pregnancy can be allowed to proceed.

    21. The clues for the sonographer in this diagnosis are the presence of a fetus (although usually with severe, but nonspecific, abnormalities) in combination with a formed placenta containing numerous cystic spaces Partial Hydatidiform Mole

    22. When Sonography alone is not sufficient.To differentiate between twin pregnancy with a normal fetus and a coexistent complete mole, AND partial molar pregnancy,

    23. RCOG Recommendations Ultrasound has limited value in detecting partial molar pregnancies. In twin pregnancies with a viable fetus and a molar pregnancy, the pregnancy can be allowed to proceed. Surgical evacuation of molar pregnancies is advisable. Routine repeat evacuation after the diagnosis of a molar pregnancy is not warranted. Registration of any molar pregnancy is essential. The combined oral contraceptive pill and hormone replacement therapy are safe to use after hCG levels have reverted to normal. Women should be advised not to conceive until the hCG level has been normal for six months or follow-up has been completed (whichever is the sooner).

    24. Evacuation of Molar Pregnancies Suction curettage is the method of choice of evacuation for complete molar pregnancies.

    25. Medical termination of complete molar pregnancies, including cervical preparation prior to suction evacuation should be avoided where possible. because of the potential to embolise and disseminate trophoblastic tissue through the venous system. Evacuation of Molar Pregnancies

    26. oxytocic infusions are only commenced once evacuation has been completed. If the patient is experiencing significant haemorrhage prior to evacuation and some degree of control is required then use of these agents will be necessary according to the clinical condition. Evacuation of Molar Pregnancies

    27. In partial molar pregnancies where the size of the fetal parts deters the use of suction curettage, medical termination can be used. (Grade C recommendation.

    30. Because persistent trophoblastic disease may develop after any pregnancy it is recommended that all products of conception obtained after repeat evacuation, performed because of persisting symptoms, should undergo histological examination. Grade C recommendation Evacuation of Molar Pregnancies

    31. There is no clinical indication for the routine use of a second uterine evacuation in the management of molar pregnancies. In cases where there are persisting symptoms after initial evacuation, consultation with the Screening Centre should be sought before surgical intervention. (Grade C recommendation) Evacuation of Molar Pregnancies

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