Types and mechanism
Normally, after fertilization, the embryo receives one set of chromosomes from each parent. With a complete hydatidiform mole, a sperm penetrates into the egg without a nucleus, and all the genetic material turns out to be paternal: the embryo is not formed at all, and the chorion tissue grows into vesicles. In the partial variant, the egg is fertilized by two sperm, the set of chromosomes turns out to be triple, and a defective fetus is found in the uterus along with an altered placenta. The full form often leads to continued tissue growth after removal, and therefore requires especially careful monitoring.
- Complete hydatidiform mole - the fetus does not form
- Partial hydatidiform mole - defective fetus and altered placenta
- Invasive mole with germination into the uterine wall
- Choriocarcinoma is a malignant form
- The common name of the group is trophoblastic disease
Symptoms
At first, everything looks like a normal pregnancy: missed period, positive test. Then, for up to 12–16 weeks, bloody discharge of varying intensity appears, sometimes with characteristic bubbles. Noteworthy is the discrepancy between the size of the uterus and the period: it is often larger than it should be. Due to very high hCG, there is painful nausea and vomiting, as well as early signs that should not be present at this stage - increased blood pressure, swelling, symptoms of excess thyroid hormones: heartbeat, trembling, sweating.
- Early bloody discharge
- Discharge of vesicles from the genital tract
- The uterus is longer than the gestational age
- Severe nausea and vomiting
- Absence of fetal movements and heartbeat
- Increased blood pressure and swelling up to 20 weeks
- Palpitations, trembling, sweating
Diagnostics
The main method is ultrasound examination: with a complete pregnancy, instead of the fertilized egg, a characteristic picture of multiple small cavities is visible, often described as a snowstorm; with partial - a fetus with gross abnormalities and an altered placenta. The second key element is the hCG level, which is usually significantly higher than normal for the term. Be sure to determine the blood type and Rh factor, evaluate the general blood count, thyroid and liver function. If the spread of the process is suspected, an X-ray or CT scan of the chest is prescribed. The diagnosis is finally confirmed by histology.
- Ultrasound of the uterus
- HCG level in blood
- General blood test
- Blood type and Rh factor
- Thyroid function assessment
- Liver and kidney parameters
- X-ray or CT scan of the chest if indicated
- Histological examination of removed tissue
Treatment
The contents of the uterus are removed, preferably by vacuum aspiration under ultrasound guidance: this method is considered safer than conventional curettage. The procedure is performed in a hospital because bleeding is possible. Women with a negative Rh factor are given anti-Rhesus immunoglobulin. Removal of the uterus is rarely considered, mainly in older women who do not plan to have children and with a high risk of continued growth. Not everyone needs chemotherapy: it is prescribed if hCG levels do not decrease as expected or begin to rise again, and in such cases it is highly effective.
- Vacuum aspiration of uterine contents under ultrasound control
- Treatment in a hospital setting
- Anti-Rhesus immunoglobulin for negative Rhesus
- Histological examination of the material
- Chemotherapy for persistent or rising hCG
- Removal of the uterus in selected cases
- Treatment of anemia and related disorders
Observation after treatment
The most important part of treatment begins after the extraction. HCG levels are measured regularly, first weekly until three consecutive negative results are obtained, then monthly for a period determined by the doctor. The point is to recognize continued growth of trophoblastic tissue early, when treatment is most effective. Reliable contraception is required for the entire observation period: a new pregnancy will make the interpretation of hCG impossible. After completion of observation, pregnancy can be planned, and in the vast majority of cases it proceeds normally.
- Weekly hCG monitoring up to three negative results
- Then monthly monitoring according to the doctor’s schedule
- Reliable contraception for the entire observation period
- Control ultrasound of the uterus
- Early ultrasound in next pregnancy
- Histological examination of the placenta in subsequent births
- Observation by a gynecological oncologist at high risk
