Molar pregnancy - Molar pregnancy Also called Gestational...

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Unformatted text preview: Molar pregnancy Also called Gestational Trophoblastic Disease/Neoplasia (GTD/GTN). This refers to a spectrum of proliferative abnormalities of the trophoblast. Symptoms Common Symptoms • vaginal bleeding • excessive uterine size • symptoms of pre-eclampsia • hyperemesis gravidarum • no foetal heart detected • symptoms of hyrotoxicosis (due to cross-reactivity of B-hCG and TSH receptors) NOTE: The lady will almost always present in the first trimester of pregnancy. Also if HTN develops < 20 weeks always consider this as a differential diagnosis. Causes The cause is not entirely known. It is thought that the pathology is due to an excess of paternal chromosomes. Complete mole = Thought to be due to 2 sperm fertilizing an empty egg or 1 sperm with reduplication potential Partial mole = Thought to be related to single ovum fertilized by two sperm Risk Factors = Previous GTD/GTN, mature maternal age, blood groups A,B,AB Epidemiology 80% benign, 15% locally invasive, 5% metastatic Diagnosis Two types: 1. Complete hydatidiform = that have 46 XX or 46 XY karyotype, which is entirely derived from paternal DNA. 15-20% risk of progression to malignancy 2. Partial hydatidiform = moles that are either 69 XXX or 69 XXY, which contain both maternal and paternal genetic material. 5% risk of progression to malignancy Investigations include: • serum beta hCG (>100,000 units/L) • serum PT, PTT (increased with bleeding and potiential DIC) • pelvic ultrasound (complete =no fetus ( "snow storm" appearance due to swelling of villi) • CXR (metastatic lesions in lungs?) ...
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Molar pregnancy - Molar pregnancy Also called Gestational...

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