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Peralta, Nickale M.

BSN II-2

Issue Year : 2004, Issue Number : 2, Issue Month : December Written By : Naila Tahir, Bushra Afzal Belongs To : Department of Gynaecology and Obstetrics Combined Military Hospital, Sialkot Cantt HYDATIDIFORM MOLE WITH NORMAL PREGNANCY - PARTIAL MOLE

Article INTRODUCTION Co-existence of an alive fetus with a hydatidiform mole is an un-common occurrence and can pose diagnostic difficulties, although the normal fetus will rarely survive under these circumstances. The pathological characteristics of partial hydatidiform mole differ from those of complete hydatidiform mole in that the former has some normal villi interspersed with hydropic villi, partial avascularity of the edematous chorionic villi and focal trophoblastic proliferation as compared to complete avascularity and diffuse trophoblastic proliferation in the latter. Fetal parts are more commonly seen in the partial mole and rarely in complete mole. Malignant potential of the two also differ. It is 15 - 20% in case of complete mole and 5% in case of partial hydatidiform mole. Ultrasound examination is a quick and reliable modality for diagnosis of the condition. It revealed an active fetus about 17 weeks gestation with hydatidiform mole. Serum Beta - Human Chorionic Gonadotrophin estimation is gold standard investigation to assess activity of molar tissue. Management is termination of pregnancy and regular follow up. We present a case of hydatidiform mole (partial mole) with pregnancy.

CASE REPORT A 30 year old third gravida both full term spontaneous vaginal deliveries reported at 17 weeks of gestation to out patient department with complaints of rapidly increasing edema both ankle for last 01 week and constant dull headache for last 03 days. There was no history of raised blood pressure during previous pregnancies. Examination revealed blood pressure 200/120 mmHg (Lying) and 170/120 mmHg (standing), moderately severe ankle oedema and a fundal height corresponding to 32 weeks gestation. Urine was checked for albumin which was present (2 grams/dl). Ultrasound examination revealed an active fetus Biparietal Diameter age 17 weeks 04 days + 09 days with a large spongiform mass occupying most of the uterine cavity. Ultrasound examination was repeated by radiologist who confirmed the diagnosis of active fetus with Hydatidiform Mole. Serum Beta - Human Chorionic Gonadotrophin was done which was 16,300 mlU/ml. The patient was admitted into hospital and termination of pregnancy planned. Vaginal examination revealed Poor Bishop score. She was put on Cap. Nifedipine 1 Cap. sub lingual, if diastolic Blood Pressure 110 mmHg or more. Extra- amniotic injection of Prostaglandin F2 Alpha diluted 1 cc in 19 cc distilled water through nasogastric tube of paediatric size passed into cervix and injected 1 cc at half hourly interval keeping a record of patients pulse and blood pressure before each injection. Patient expelled a dead fetus of about 16 weeks gestation after 08 extra - amniotic injections with a hand full of molar tissue. Rest of molar tissue along with placenta was removed under general anaesthesia by suction curettage. 40 IU syntocinon in 1.0 litre of Ringers Solution was continued during evacuation and for 04 hours afterwards. The diagnosis of partial mole was later on confirmed on histopathological examination of the molar tissue. Karyotyping was also done and it was triploid (69XXX). After evacuation, uterus was 14 weeks gestation size. Patient had a smooth recovery, the symptoms regressed and blood pressure dropped to normal within 48 hours. Patient was discharged from hospital on second post operative day with advice for regular follow up.