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

Trophoblastic proliferation

Uterus expands faster than normal

Abdominal pain

High secretion of hCG High progesterone

low estrogen

High chorionic thyrotropin

Marked nausea & vomiting

Decreased contraction Separation of vesicles from uterine wall

Amenorrhea Hyperthyroidism

Multiple theca lutein cysts in the ovaries
Ovarian pain

Vaginal bleeding & discharge of vesicles

Enlarged thyroid gland; tachycardia



Note: Those inside the boxes end up as the signs & symptoms of H mole.


A partial mole has 69 chromosomes (a triploid formation in which there is three chromosomes instead of two for every pair. 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. a rapidly metastasizing malignancy. As the cells degenerate. this chromosome component was contributed only by a father or an “empty ovum” was fertilized and the chromosome material was duplicated (Fig. 1. Such structures must be identified because they are associated with choriocarcinoma. Two types of molar growth can be identified by chromosomal analysis: Complete Mole: All trophoblastic villi swell and become cystic. A macerated embryo of approximately 9 weeks. grape-sized vesicles.500 pregnancies. gestation may be present in the villi. The syncytiotrophoblastic layer of the villi. partial moles rarely lead to choriocarcinoma. Ovum 2 3 6 9 + = 3 + 2 3 + 2 3 = 6 9 . On chromosomal analysis. although the karyotype is a normal 46XX or 46XY. It is an abnormal proliferation and degeneration of the trophoblastic villi. the embryo fails to develop beyond a primitive start. If an embryo forms. With this condition. Sperm 4 6 or Fig. is swollen and misshapen. WHAT IS GESTATIONAL TROPHOBLASTIC DISEASE? Gestational Trophoblastic Disease. In contrast to complete moles.Complete mole. 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). with no fetal blood present in the villi. they become filled with fluid and appear as clear fluid-filled. some of the villi form normally. 2. however. 2). Ovum + + Duplication = 4 6 Partial Mole: With a partial mole. 1). is a condition associated with second-trimester bleeding. it dies early at only 1 to 2 mm in size. Sperm 2 3 Fig. Partial 2 mole.II. The incidence of gestational trophoblastic disease is approximately 1 in every 1. existing in many terms like Hydatidiform Mole.

colicky due to start of expulsion 6. ovarian pain due to stretching of ovarian capsule or complication in the cystic ovary as torsion B. Molar pregnancy has no racial or ethnic predilection. B. PREDISPOSING FACTORS A. Blood may be concealed in the uterus. although Asian countries show a rate 15 times higher than the US rate. Symptoms: 1. 5. C. Diet: Low CHON and low Vitamin A (carotene) intake. Signs: 1. thereby causing enlargement. 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. symptoms of preeclampsia that may be present as headache and edema 4. 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) . pallor indicating anemia may be present 3. preeclampsia develops in 20 – 30 % cases. Various features of a complete and a partial mole. Age: Women older than 35 years. Race: Asian heritage. amenorrhea 2. vaginal bleeding as the main complaint. exaggerated symptoms of pregnancy especially vomiting 3. IV. GTD is higher toward the beginning and toward the end of child bearing period. abdominal pain: may be dull-aching due to rapid distension of uterine by mole or by concealed hemorrhage. due to the separation of vesicles from the uterine wall and there may be blood-stained. usually before 20 weeks’ AOG 2. III. It is ten times more in women who are 45 years old and beyond.• FEATURES Embryonic/fetal tissue Absent Diffuse COMPLETE (whole conceptus is PARTIAL Present (with fetus or at least an amniotic sac) Focal Focal transformed into a mass of vesicles) • • • • Diffuse Paternal 46XX (97%) or 46XY (47%) 5-10% Malignant changes Swelling of villi Trophoblastic hyperplasia Karyotype Paternal and maternal 69XXY or 69XYY Rare Table 1. SIGNS AND SYMPTOMS A.

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