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(Gestational Trophoblastic Disease; Molar Pregnancy)
A hydatidiform mole is growth of an abnormal fertilized egg or an overgrowth of tissue from the placenta.
Women appear to be pregnant, but the uterus enlarges much more rapidly than in a normal pregnancy.
Most women have severe nausea and vomiting, vaginal bleeding, and very high blood pressure.
Ultrasonography, blood tests to measure human chorionic gonadotropin (which is produced early during pregnancy) and a biopsy are done.
Moles are removed using dilation and curettage (D and C) with suction.
If the disorder persists, chemotherapy is needed.
Most often, a hydatidiform mole is an abnormal fertilized egg that develops into a hydatidiform mole rather than a fetus (a condition called molar pregnancy). However, a hydatidiform mole can develop from cells that remain in the uterus after a miscarriage or a full-term pregnancy. Rarely, a hydatidiform mole develops when there is a living fetus. In such cases, the fetus typically dies, and a miscarriage often occurs.
Hydatidiform moles are most common among women under 17 or over 35. In the United States, they occur in about 1 in 2000 pregnancies in the United States. For unknown reasons, moles are almost 10 times more common in Asian countries.
About 80% of hydatidiform moles are not cancerous. About 15 to 20% invade the surrounding tissue and tend to persist. Most of these moles are invasive moles (called chorioadenoma destruens). About 2 to 3% become cancerous and spread throughout the body. They are then called choriocarcinomas. Choriocarcinomas can spread quickly through the lymphatic vessels or bloodstream.
Hydatidiform moles, invasive moles, and choriocarcinomas are types of gestational trophoblastic disease.
Women who have a hydatidiform mole feel as if they are pregnant. But because hydatidiform moles grow much faster than a fetus, the abdomen becomes larger much faster than it does in a normal pregnancy. Severe nausea and vomiting are common, and vaginal bleeding may occur. As parts of the mole deteriorate, small amounts of tissue, which resemble a bunch of grapes, may pass through the vagina. These symptoms indicate the need for prompt evaluation by a doctor.
Hydatidiform moles can cause serious complications, including infection of the uterus, a widespread infection of the blood (sepsis), and dangerously low blood pressure (shock) or very high blood pressure with increased protein in the urine (preeclampsia or eclampsia—see Preeclampsia and Eclampsia).
If choriocarcinoma develops, women may have other symptoms, caused by spread (metastasis) to other parts of the body.
Often, doctors can diagnose a hydatidiform mole shortly after conception. The pregnancy test is positive, but no fetal movement and no fetal heartbeat are detected, and the uterus is much larger than expected.
Ultrasonography is done to be sure that the growth is a hydatidiform mole and not a fetus or amniotic sac (which contains the fetus and fluid around it). Blood tests to measure the level of human chorionic gonadotropin (hCG—a hormone normally produced early in pregnancy) are done. If a hydatidiform mole is present, the level is usually very high because the mole produces a large amount of this hormone. A sample of tissue is removed during D and C or obtained when tissue is passed and is then examined under a microscope (biopsy) to confirm the diagnosis.
With treatment, many women are cured. The likelihood of cure depends on whether the mole has spread and other factors:
Most women who have had a hydatidiform mole can have children afterward and do not have a higher risk of a miscarriage, complications during pregnancy, or children with birth defects.
About 1% of women who have had a hydatidiform mole have another one. So if women have had a hydatidiform mole, ultrasonography is done early in subsequent pregnancies.
A hydatidiform mole is completely removed, usually by dilation and curettage (D and C) with suction (see Diagnostic Procedures : Dilation and Curettage). Only rarely is removal of the uterus (hysterectomy) necessary.
A chest x-ray is taken to see whether the mole has spread to the lungs (that is, become a choriocarcinoma). The x-ray can be taken before or after the mole is removed.
After surgery, the level of human chorionic gonadotropin in the blood is measured to determine whether the hydatidiform mole was completely removed. When removal is complete, the level returns to normal, usually within 10 weeks, and remains normal, and no further treatment is needed. If the level does not return to normal, the disease is considered persistent. Then, computed tomography (CT) of the brain, chest, abdomen, and pelvis is done to determine whether choriocarcinoma has developed and spread.
If the mole persists or has spread but is considered low risk, chemotherapy is needed. Chemotherapy may consist of only one drug (methotrexate or dactinomycin), both of these drugs, or another combination of chemotherapy drugs (such as etoposide, methotrexate, actinomycin-D, cyclophosphamide, and vincristine). If the mole has spread widely and is considered high risk, several chemotherapy drugs are used.
Women who have had a hydatidiform mole removed are advised not to become pregnant for 6 months to 1 year. Oral contraceptives are frequently recommended, but other effective contraceptive methods can be used.
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