PATHOPHYSIOLOGY

Low intake of proteins and vitamin A, Asian heritage, Women older than 35 years

Partial mole
or
Complete mole

Chronic villi degenerates and become filled with fluid

No vasculature in chorionic villi

Early death & absorption of embryo Absence of FHT

Uterus
expands Abdominal
Trophoblastic proliferation faster than pain
normal

High secretion of hCG High progesterone low estrogen High chorionic

thyrotropin

Decreased contraction Amenorrhea

Marked nausea &
vomiting Hyperthyroidism

Separation of vesicles from

uterine wall
Multiple theca lutein cysts Enlarged thyroid
in the ovaries gland; tachycardia
Vaginal bleeding &
discharge of vesicles

Ovarian
pain

Pallor Preeclampsia

Note: Those inside the boxes end up as the signs & symptoms of H mole.
 II. WHAT IS GESTATIONAL TROPHOBLASTIC DISEASE?

Gestational Trophoblastic Disease, existing in many terms like Hydatidiform Mole, is a condition associated
with second-trimester bleeding. It is an abnormal proliferation and degeneration of the trophoblastic villi. As the cells
degenerate, they become filled with fluid and appear as clear fluid-filled, grape-sized vesicles. With this condition, the
embryo fails to develop beyond a primitive start. Such structures must be identified because they are associated with
choriocarcinoma, a rapidly metastasizing malignancy. The incidence of gestational trophoblastic disease is
approximately 1 in every 1,500 pregnancies.

Two types of molar growth can be identified by chromosomal analysis:

Complete Mole: All trophoblastic villi swell and become cystic. If an embryo forms, it dies early at only 1 to 2 mm in
size, with no fetal blood present in the villi. On chromosomal analysis, although the karyotype is a normal 46XX or
46XY, this chromosome component was contributed only by a father or an “empty ovum” was fertilized and the
chromosome material was duplicated (Fig. 1).

Sperm Ovum
2 4
3 + + Duplication = 6

Fig. 1.Complete mole.

Partial Mole: With a partial mole, some of the villi form normally. The syncytiotrophoblastic layer of the villi, however,
is swollen and misshapen. A macerated embryo of approximately 9 weeks; gestation may be present in the villi. A
partial mole has 69 chromosomes (a triploid formation in which there is three chromosomes instead of two for every
pair, one set supplied by an ovum that apparently was fertilized by two sperm or an ovum fertilized by one sperm in
which meiosis or reduction division did not occur). This could also occur if one set of 23 chromosomes was supplied
by one sperm and an ovum did not undergo reduction division supplied 46 (see Fig. 2). In contrast to complete moles,
partial moles rarely lead to choriocarcinoma.

Sperm Ovum

4 2 6
6 + 3 = 9

or

Fig. 2. Partial 2
mole.
3
2 6
+ + 3 = 9

2
3
 FEATURES COMPLETE PARTIAL
• Embryonic/fetal tissue Absent (whole conceptus is Present (with fetus or at least an
transformed into a mass of vesicles) amniotic sac)
Diffuse
• Swelling of villi Diffuse Focal

• Trophoblastic hyperplasia Focal

• Karyotype Paternal 46XX (97%) or 46XY (47%)

5-10% Paternal and maternal 69XXY or
69XYY
• Malignant changes
Rare

Table 1. Various features of a complete and a partial mole.

III. PREDISPOSING FACTORS

A. Diet: Low CHON and low Vitamin A (carotene) intake.

B. Age: Women older than 35 years. GTD is higher toward the beginning and toward the end of child bearing period.
It is ten times more in women who are 45 years old and beyond.
C. Race: Asian heritage. Molar pregnancy has no racial or ethnic predilection, although Asian countries show a rate
15 times higher than the US rate.

IV. SIGNS AND SYMPTOMS

A. Symptoms:
1. amenorrhea
2. exaggerated symptoms of pregnancy especially vomiting
3. symptoms of preeclampsia that may be present as headache and edema
4. vaginal bleeding as the main complaint; due to the separation of vesicles from the uterine wall and there
may be blood-stained, watery discharge (the watery part is from the ruptured vesicles)
• Prune juice-like discharge may occur brownish because it is retained for sometime inside the
uterine cavity.
• Blood may be concealed in the uterus, thereby causing enlargement.
5. abdominal pain: may be dull-aching due to rapid distension of uterine by mole or by concealed
hemorrhage; colicky due to start of expulsion
6. ovarian pain due to stretching of ovarian capsule or complication in the cystic ovary as torsion

B. Signs:
1. preeclampsia develops in 20 – 30 % cases, usually before 20 weeks’ AOG
2. pallor indicating anemia may be present
3. hyperthyroidism develops in 3-10% of cases manifested by enlarged thyroid gland and tachycardia (due
to chorionic thyrotropin secreted by the trophoblast and hCG also has a thyroid-stimulating effect)