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Fetopathology and developmental pathology of the embryo and fetus
Marta Ježová, Josef Feit et al.
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Hydatidiform mole
Clinical signs
  • Risk factors:
    • age: Hydatidiform mole occur in women durign the whole reproductive period, the highest incidence (per pregnancy) is in women over 40
    • ethnicity: Asian ethnicity is a significant risk factor. The occurence of hydatidiform mole is several fold greater in Indonesia, Japan, Philippines than in Europe
    • prior molar pregnancy: Prior molar pregnancy increases the risk of reccurence up to 1 : 100, two prior molar pregnancies mean the risk of reccurence 1 : 30
  • general incidence: The estimated occurence of hydatidiform mole in our population is 1 in 2500 — 3000 of recognised pregnancies
  • therapy: Suction evacuation of mole and revision of the uterine cavity by curretage afterwards are performed. hCG titers must be followed up after the evacuation of mole until the levels return to normal. Serum hCG titers are assesed weekly until normal, then monthly for 1 year in complete mole, for half year in partial mole. A period of 6 to 12 months is reccomended betweeen the hCG drop and another conception. There is a significant risk of reccurent molar pregnancy (see above).
  • Persistent gestational trophoblastic disease: Increasing or plateuing hCG titers after evacuation of mole mean that a trophoblastic cells population persists in the body. This is called persistent gestational trophoblastic disease. Residual hydatidiform mole retained in the uterine cavity, residual trophoblast, invasive mole or choriocarcinoma explain the persistent hCG titres. The definite histologic diagnosis is often never confirmed. The guidelines for therapy are based on future risk assessment: stage of GTD (stage 1is disease confined to uterus clinically, stage 2 — 4 metastatic disease) and known risk factors for poor outcome.
Classification
  1. Complete mole
  2. Partial mole

These subtypes have different clinical, pathologic and genetic features and particularly prognosis.

Complete mole
Partial mole