Hydatiform Mole

Subject: Midwifery I (Theory)

Overview

A hydatiform mole is a trophoblastic malformation in which the chorionic villi proliferate and become vascular, resulting in the creation of an enormous irregular cluster and chain of cysts ranging in size from a pinhead to a huge grape. The specific cause is unknown, but other risk factors include a weakened immune system, genetic and chromosomal abnormalities, a history of hydatiform mole, and a poor diet high in carbohydrates, low in protein, and insufficient in folic acid and other vitamins. Vaginal bleeding occurs around the 12th week. Its hue could be bright red or dark brown, and it has never felt fetal movement, pain, soreness in the belly, or extreme distension.

A hydatiform mole is a large trophoblast malformation in which the chorionic villi multiply and become vascular, resulting in the creation of an enormous irregular cluster and chain of cysts ranging in size from a pinhead to a small grape. It appears to be a collection of groups. It is an uncommon lump or growth that develops inside the womb at the start of a pregnancy. The embryo or fetus dies and is absorbed in this process.

Incidence

The prevalence varies.

Classification

  1. Hydatiform mole
  2. Complete mole
  3. Incomplete or partial mole
  4. Invasive mole
  5. Gestational choriocarcinoma
  6. Placental site trophoblastic tumor

Etiology

  1. The precise etiology is unknown, however, there are some predisposing factors:
  2. Teenagers and people aged 35 and up are at a higher risk.
  3. A poor diet that is heavy in carbohydrates, low in protein, and low in folic acid and other vitamins.
  4. Immune system dysfunction
  5. Anomalies of the genome and chromosomes
  6. Previous hydatiform mole history

Risk Factor

  1. Age of the mother (over 35 years old, younger than 20 age)
  2. Previous mole history

Signs and Symptoms

  1. Amenorrhea history
  2. Vaginal bleeding around the 12th week. It could be brilliant red or dark brown.
  3. Under uterine hypertrophy,
  4. Has never experienced fetal movement
  5. No fetal heart rate.
  6. No fetal part felt.
  7. Abdominal pain and tenderness, as well as severe distension
  8. Vomiting in excess
  9. Anemia causes shortness of breath.
  10. Loss of weight
  11. Hands trembling
  12. Positive pregnancy test and shady urine

Investigation

  1. Pelvic examination
  2. Blood test for HCG
  3. CT or MRI of the abdomen CBC, grouping, clotting time RFT, LFT

Complication

  1. Because of anemia, hemorrhage and shock are more prevalent.
  2. Sepsis
  3. Preeclampsia
  4. Thyroid issues
  5. Choriocarcinoma
  6. Failure of Coagulation
  7. Acute pulmonary insufficiency as a result of the embolism

Management

  1. The woman should be hospitalized.
  2. Maintain full bed rest for the woman.
  3. Hemoglobin blood test, grouping crossmatch
  4. Urine examination
  5. To limit the risk of infection, clean the vulva aseptically.
  6. All vital signs of the woman should be monitored and recorded every four hours.
  7. Prophylactic antibiotics are used to prevent infection.
  8. Medical initiation (syntaxin drip). If this fails, the cervix may dilate. However, due to the risk of perforating the uterine wall, no curetting is permitted.
  9. To avoid hemorrhage once the evacuation is underway, infuse 20 units of oxytocin in 1 liter of IV fluids (normal saline or ringer lactate) and administer 60 drops per minute.
  10. Transfusion of blood in circumstances of severe hemorrhage
  11. In a hysterectomy scenario, administer methergine 0.2mg intramuscularly to reduce blood loss.
  12. To limit the risk of infection, maintain a good aseptic technique during surgical evacuation.
  13. Antibiotics should be accompanied by vitamin B complex.
  14. Provide iron tablets and encourage patients to continue for one to two months.
  15. Chemoprevention in high-risk patients
  16. Complication avoidance
  17. Because of the potential of persisting trophoblastic illness or choriocarcinoma, a urine test for pregnancy conforms should be performed every 8 weeks for at least a year. If the urine test remains negative after 8 weeks or becomes positive, the woman should be referred to a tertiary care center for additional management and follow-up.

References

  • NYTimes. 15. March 2017 http://www.nytimes.com/health/guides/disease/hydatidiform-mole/overview.html
  • MedicineNet. 1996. 2017 http://www.medicinenet.com/script/main/art.asp?articlekey=3824
  • Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/000909.htm
  • Medscape. 1994. 2017 http://emedicine.medscape.com/article/254657-overview?pa=KqorlYO7sUUOwExfjhS2RJO2BYNePPWAbwvolalcAgzYiObuOUaH6R5ntGkbq7vzNGuJG1mywi6g1p6WZQ2HaOejCO3Rk4DWsD37DrSZWvU%3D
  • Tuitui R. 2002, A textbook of Midwifery A (Antenatal), 3rd edition, Vidyarthi Pustak Bhnadar (Publisher and Distributor), Bhotahity, Kathmandu
Things to remember
  • A hydatiform mole is a large trophoblast malformation in which the chorionic villi multiply and become vascular, resulting in the creation of an enormous irregular cluster and chain of cysts ranging in size from a pinhead to a small grape.
  • It appears to be a collection of groups.
  • It is an uncommon lump or growth that develops inside the womb at the start of a pregnancy.
  • The embryo or fetus dies and is absorbed in this process.
  • The specific cause is unknown, but other predisposing factors include a weakened immune system, genetic and chromosomal abnormalities, a history of hydatiform mole, and a defective diet high in carbohydrate, low in protein, and insufficient in folic acid and other vitamins.
  • Signs and symptoms include vaginal bleeding during the 12th week. Its hue may be brilliant red or dark brown, and it has never felt fetal movement, pain and soreness in the belly, severe distension, excessive vomiting, and so on.
Questions and Answers

The term "hydatiform mole" refers to a severe trophoblastic malformation in which the chorionic villi proliferate and become vascular, and which is characterized by the development of enormous, irregular clusters and chains of cysts that range in size from a pinhead to a small grape. There appear to be numerous groups. At the start of pregnancy, an uncommon mass or growth develops inside the womb.

Etiology

  • Although the precise reason is uncertain, there are additional predisposing factors:
  • Teenagers and those 35 years of age and older are more likely to experience it.
  • A poor diet with a high carbohydrate, low protein, and vitamin and folic acid deficiency.
  • Impaired immune system
  • Anomalies in the chromosomes and genes
  • Existence of a hydatiform mole in the past

Risk Factor

  • Mother's age
  • Previous mole history

Signs and Symptoms

  • Previous amenorrhea
  • Hemorrhage about the 12th week or so. It may be dark brown and bright red in color.
  • Under uterine hypertrophy,
  • Never experienced fetal movement
  • Fetal heart rate absent
  • Nothing fetal was felt
  • Abdominal discomfort and pain, severe distension
  • A lot of vomiting
  • Anemia-related breathlessness
  • Loss of weight
  • Shaking hands
  • Negative pregnancy test and scant urine

Management

  • She was taken to a hospital.
  • Keep the woman in bed and only in bed.
  • Hemoglobin level blood test with cross-matching.
  • Urine examination
  • Utilizing aseptic technique, clean the vulva to lower the risk of infection.
  • Record and monitor the woman's vital indicators every four hours.
  • Antibiotics are administered as a preventive measure to lessen the illness.
  • Introducing a doctor (syntocin drip). The cervix can be dilated if it fails. However, due to the possibility of perforating the uterine wall, curetting is not recommended.
  • Once the evacuation has begun, provide 60 drops of oxytocin at a rate of 20 units per liter of normal saline or ringer lactate IV fluids to prevent bleeding.
  • A blood transfusion is performed when bleeding is severe.
  • Methergine 0.2 mg IM injection is used during hysterectomy procedures to reduce blood loss.
  • To lower the risk of infection, use high aseptic technique during surgical evacuation.
  • Along with antibiotics, give vitamin B complex.
  • Give iron tablets and advise taking them for one to two months.
  • Chemotherapy given before surgery in high-risk situations.
  • Prevention of complications.
  • Due to the possibility of choriocarcinoma or persistent trophoblastic illness, follow-up with a urine test for pregnancy should be done every eight weeks for at least a year. After eight weeks, if the urine test is still negative or turns positive, refer the woman to a tertiary care facility for additional therapy and follow-up.

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