Molar pregnancy

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Parental originIn most complete moles, all nuclear genes are inherited from the father only (androgenesis). In approximately 80% of these androgenetic moles, the most probable mechanism is that an empty egg is fertilized by a single sperm, followed by a duplication of all chromosomes/genes (a process called “endoreduplication”). In approximately 20% of complete moles, the most probable  Anesthesia Management: The uterine curettage is generally done under the effect of anesthesia, preferably spinal anesthesia in hemodynamically stable patients. The advantages of spinal anesthesia over general anesthesia include ease of technique, favorable effects on the pulmonary system, safety in patients with hyperthyroidism and non-tocolytic pharmacological properties. Additionally, by maintaining patient’s consciousness one can diagnose the complications like uterine perforation, cardiopulmonary distress and thyroid storm at an earlier stage than when the patient is sedated or is under general anesthesia. Management is more complicated when the mole occurs together with one or more normal fetuses.

PrognosisMore than 80% of hydatidiform moles are benign. The outcome after treatment is usually excellent. Close follow-up is essential. Highly effective means of contraception are recommended to avoid pregnancy for at least 6 to 12 months.In 10 to 15% of cases, hydatidiform moles may develop into invasive moles. This condition is named persistent trophoblastic disease . The moles may intrude so far into the uterine wall that hemorrhage or other complications develop. It is for this reason that a post-operative full abdominal and chest x-ray will often be requested.In 2 to 3% of cases, hydatidiform moles may develop into choriocarcinoma, which is a malignant, rapidly-growing, and metastatic (spreading) form of cancer. Despite these factors which normally indicate a poor prognosis, the rate of cure after treatment with chemotherapy is high.Over 90% of women with malignant, non-spreading cancer are able to survive and retain their ability to conceive and bear children. In those with metastatic (spreading) cancer, remission remains at 75 to 85%, although their childbearing ability is usually lost.

Molar pregnancy is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus and converts a normal pregnancy into an abnormal one (which will fail to come to term). A molar pregnancy is a gestational trophoblastic disease that grows into a mass in the uterus that has swollen chorionic villi. These villi grow in clusters that resemble grapes. A molar pregnancy can develop when an egg that is missing its nucleus is fertilized and that may or may not contain fetal tissue. It is characterized by the presence of  a hydatidiform mole (or hydatid mole, mola hydatidosa).  Molar pregnancies are categorized into partial and complete moles. Mole as used here simply indicates clump of growing tissue, or a ‘growth’.A complete mole is caused by a single (90%) or two (10%) sperm combining with an egg which has lost its DNA (the sperm then reduplicates forming a “complete” 46 chromosome set)  The genotype is typically 46,XX (diploid) due to subsequent mitosis of the fertilizing sperm, but can also be 46,XY (diploid).[4] 46,YY (diploid) is not observed. In contrast, a  partial mole  occurs when an egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid) or 92,XXXY (tetraploid).[4] Complete hydatidiform moles have a higher risk of developing into choriocarcinoma — a malignant tumor of trophoblast cells — than do partial moles. The etymology is derived from hydatisia (Greek “a drop of water referring to the watery contents of the cysts, and mole (from Latin mola = millstone/false conception). The term, however, comes from the similar appearance of the cyst to a hydatid cyst in an Echinococcosis.A hydatidiform mole conception may be categorized in medical terms as one type of non-induced (natural) “missed abortion – referred to colloquially as a “missed miscarriage”, because the pregnancy has become non-viable (miscarried) but was not immediately expelled (therefore was “missed”mechanism is that an empty egg is fertilised by two sperm. In both cases, the moles are diploid. In all these cases, the mitochondrial genes are inherited from the mother, as usual. Most partial moles are triploid (three chromosome sets). The nucleus contains one maternal set of genes and two paternal sets. The mechanism is usually the reduplication of the paternal haploid set from a single sperm, but may also be the consequence of dispermic (two sperm) fertilization of the egg. In rare cases, hydatidiform moles are tetraploid (four chromosome sets) or have other chromosome abnormalities.

Treatment.

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