Name
HYDATIDIFORM MOLE
DESCRIPTION
DETAIL
D.D. - MISTAKEN DATE - MULTIPLE PREGNANCIES - ACUTE HYDRAMNIOS - A FIBROID IN PREGNANCY - THREATENED ABORTIONOTHER TESTS : * BETA-HCG LEVELS ARE HIGHER THAN EXPECTED (>100,000 MLU/ML ) INDICATE EXUBERANT TROPHOBLASTIC GROWTH & SUSPECION OF MOLAR PREGNANCY. * PTS SUSPECTED OF MOLAR PREGNANCY REQUIRES A CHEST X-RAY, CAREFUL PELVIC EXAMINATION TO RULE OUT METASTASIS & WEEKLY SERIAL MONITORING OF BETA-HCG LEVELS. * CLOTTING FUNCTION - TEST CLOTTING FUNCTION TO EXCLUDE COAGULOPATHY. * LFT * BLOOD UREA NITROGEN & SERUM CREATININE * THYROXIN - MAY BE ELEVATED * SERUM INHIBIN A & ACTIVIN A LEVELS - HIGH IN MOLAR PREGNANCY THAN NORMAL PREGNANCY.
TYPENOTES
Medical Care: Stabilize the patient. Transfuse for anemia. Correct any coagulopathy. Treat hypertension. Surgical Care: Evacuation of the uterus by dilation and curettage is always necessary. Prostaglandin or oxytocin induction is not recommended because of the increased risk of bleeding and malignant sequelae. Intravenous oxytocin should be started with the dilation of the cervix and continued postoperatively to reduce the likelihood of hemorrhage. Consideration of using other uterotonic formulations (eg, Methergine, Hemabate) is also warranted. Respiratory distress is often observed at the time of surgery. This may be due to trophoblastic embolization, high-output congestive heart failure caused by anemia, or iatrogenic fluid overload. Distress should be aggressively treated with assisted ventilation and monitoring, as required. Diet: No special diet is required. Activity: Patients may resume activity as tolerated. Pelvic rest is recommended for 4-6 weeks after evacuation of the uterus, and the patient is instructed not to become pregnant for 12 months. Adequate contraception is recommended during this period. Monitor serial beta-HCG values to identify the rare patient who develops malignant disease. If a pregnancy does occur, the elevation in beta-HCG would be confused with development of malignant disease. Further Outpatient Care: Serial quantitative beta-HCG levels should be determined. Draw the first level 48 hours after evacuation and then every 2 weeks until the levels are within reference ranges. Levels should consistently drop and should never increase. Once levels have reached reference ranges, check them each month for a year. Any rise in levels should prompt a chest radiograph and pelvic examination to facilitate early detection of metastases. Contraception is recommended for 6 months to a year after evacuation. Patients with a prior complete or partial molar pregnancy have a 10-fold risk of a second mole in a future pregnancy. Evaluate all future pregnancies early with ultrasonography.
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
X-RAY CHEST P.A. VIEW( NORMAL ), ULTRA SOUND OBSTETRICS, BETA HCG ( FEMALE ), COLOR DOPPLER