HYDATIFORM MOLE INTODUCTION: Gestational trophoblast disease encompasses several disease processes that originate in the placenta.

These include complete and partial moles, placental site trophoblast tumours, choriocarcinomas, and invasive moles. Almost all women with malignant gestational trophoblast disease can be cured with preservation of reproductive function. The following discussion is limited to hydatidiform moles (complete and partial). DEFINITION: It is also known as vesicular mole is due to cystic degenerative changes in chorionic villi resulting in death of fetus conversion of chorionic villi into large number of vesicles. They resemble hydatid cysts hence known as mole. It is best regarded as benign neoplasm of the chorion with malignant potential. INCIDENCE: Its incidence varies from country the highest incidence is in !hilippines being " in #$ pregnancies lowest in %uropean countries &'A. In India incidence is " in ($$. PATHOLOGY: A normal chorionic villus consist of core of my)oid connective tissue carrying fetal blood vessels surrounded by a trophoblast which consist of an inner langhan*s layer an outer syncytial layer. After the fourth month the langhan*s layer atrophies while connective tissue core becomes fibrous vascular. In placenta (abnormal condition)

+oung chorionic villi undergoes

!artly degenerative changes

partly proliferative changes

,o interillous -lood circulation

villi filled with fluid

villi continue to multiply

uterine enlargement

.ormation of clusters of small cyst of varying degree bunch of grapes

collectively takes appearance of a

Choriodecidual spaces become obliterated

,o intervillous blood circulation

-lood not reaches to fetus

Maternal blood cannot circulate

,o o)ygen

nutrient to fetus

.etus dies CLINICAL FEATURES:

becomes absorbed

Age & parity: it is prevalent amongst teenaged elderly patients with high parity. The patient gives history of amenorrhoea of #/"0 weeks with initial features suggestive of normal pregnancy but subse1uently presents with the following manifestations. Symptom :

". !agi"a# $#ee%i"g: it is the commonest presentation. It may be produced by a appearance or watery discharge. The blood may be mi)ed with fluid from ruptured cysts giving the appearance of discharge 2white currant in red currant 3uice4. 0. !aryi"g %egree o& #o'er a$%omi"a# pai" may $e %(e to: over distension of the uterus, concealed haemorrhage, rarely perforation of the uterus by the invasive mole, infection uterine contractions to e)pel out the contents. )* Co" tit(tio"a# ymptom :

The patient becomes sick without any apparent reason. 5omiting of pregnancy becomes e)cessive to the stage of 6yperemesis in "78 cases. -reathlessness due to pulmonary embolisation of the trophoblastic cells. Thyroto)ic features of tremors or tachycardia are present on occasion. It is probably due to increased chorionic thyrotrophic. %)pulsion of grapes like vesicles per vaginam is diagnostic of vesicular mole. +* Sig" : .eatures suggestive of early months of pregnancy are evident.

 The patient looks more ill than can be accounted for. !allor is unusually prominent out of promotion to the visible blood loss concealed haemorrhage. may be due to

It is mostly due to iron deficiency but may be megaloblastic due to folic acid deficiency. .eatures of pre/eclampsia are present in about 7$8. 9n rare occasion convulsion may occur. The pre/eclamptic process may be due to over distension of the uterus or more probably due to hyperactivity of the trophoblastic cells.

,* Per a$%ome": The si:e of the uterus is more than that e)pected for the period of amenorrhoea in ;$8 corresponds with period of amenorrhoea in 0$8 smaller than the period of amenorrhoea in "$8. The fre1uent findings of undue enlargement of the uterus are due to e)uberant growth of the vesicles the concealed haemorrhage. The feel of the uterus s