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Vesicular Mole

By AdminPosted On 05-Oct-2016

1. Vesicular Mole Symptoms


Signs and symptoms of Hydatidiform mole include the following EXCEPT


a) 1st trimester bleeding

b) A Uterus larger than expected gestational age

c) Hypothyroidism

d) Pre-eclampsia

e) Nausea and vomiting

Correct Answer: c) Hypothyroidism. Human chorionic gonadotropin (hCG), which has thyrotropic activity, is believed to be responsible for hyperthyroidism of gestational trophoblastic activity and hyperemesis gravidarum.


2. Vesicular Mole Histopathology


Histopathology showing oedematous villi surrounded by hyperplasia of the trophoblastic tissue. There is no normal embryonic tissue. No features suggestive of malignancy are seen. At dilatation and curettage, the uterus was soft and bulky and was big for 8 week pregnancy.


a) Choriocarcinoma

b) Complete Hydatidiform mole

c) Missed miscarriage

d) Partial mole

e) Placental site nodules


Correct Answer: b) Complete hydatidiform mole. A partial mole will have only some villi dilated and other villi are normal or small and fibrotic. Placental site nodules are small circumscribed foci of the hyalinised implantation site containing intermediate trophoblastic tissue.


3. High Risk Mole


In a case of Vesicular mole all of following are high risk factors for the development of choriocarcinoma except


a) Serum HCG levels >100,000 mIU/ml

b) Excessive uterine enlargement

c) Anaemia

d) Presence of bilateral theca lutein cysts of ovary ≥6cm in size

Correct Answer: c) Anaemia.

Except anaemia all three options are considered as the high risk in a complete hydatidiform mole. Any one of these signs is considered high risk. Here high risk is potential for local invasion and dissemination. After molar evacuation, local uterine invasion occurs in 15% and metastasis occurs in 4%.

(Ref – Novak’s Gynecologyy)


4. The genetic make up of complete hydatiform mole typically is


a) 46, XX paternal only.

b) 46, XX maternal only

c) 46, XY paternal only

d) 46 XX, maternal and paternal.

e) Triploidy

Correct Answer: a) 46, XX paternal only. 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).


5. β-hCG Titer


After the β-hCG titer becomes undetectable, the patient treated for Hydatidiform mole should be followed with monthly titers for a period of


a) 3 months.

b) 6 months.

c) 1 year.

d) 2 years.

e) 5 years.

Correct Answer: Partially correct c) 6 months. Follow up after GTD is increasingly individualized.

1) If hCG has reverted to normal within 56 days of the pregnancy event then follow up will be for 6 months from the date of uterine evacuation.

2) If hCG has not reverted to normal within 56 days of the pregnancy event then follow-up will be for 6 months from normalisation of the hCG level. (RCOG Guideline: 2010)


6. Choriocarcinomas can occur


a) After abortion.

b) Spontaneously.

c) After Hydatiform mole.

d) After normal pregnancy.

Correct Answer: a,b,c,d. All. Choriocarcinoma of the placenta during pregnancy is preceded by:

1) hydatidiform mole (50%)

2) spontaneous abortion (20%)

3) ectopic pregnancy (2%)

4) normal term pregnancy (20-30%)

Rarely, choriocarcinoma occurs in testis and ovary spontaneously.


7. Contraception of choice for vesicular mole


Contraception of choice for vesicular mole (hydatidiform mole) until after the completion of the surveillance period in those patients who have had evacuation for 12 months mainly to avoid potential teratogenic effects of chemotherapy and confusion regarding hCG values.


a) Oral contraceptives

b) Barrier contraception

c) IUCD

d) Progesterone only contraception


Correct Answer: a) Oral contraceptives.


Effective contraception is recommended during the period of follow-up. The average time to achieve the first normal hCG level after evacuation is about 9 weeks. Oral contraceptives do not increase the incidence of postmolar gestational trophoblastic disease or alter the pattern of regression of hCG values (Ref: Novak's Gynecology). IUCD insertion should await involution of the uterus and normalization of serum hCG levels to avoid perforation. Barrier contraception can also be used but it is less effective than OC's and IUCD. Here we need effective contraception, so barrier contraception is not the option.


8. When to start OC Pills after treatment of Vesicular Mole?


a) Immediately after evacuation

b) After 9 weeks

c) After normalization of hCG titer

d) Should not be given

Correct Answer: a) Immediately after evacuation. After a hydatidiform mole, the risk of developing a second mole is 1.2-1.4%. The risk increases to 20% after 2 moles. As effective contraception is recommended during the period of follow-up, Oral contraceptive pills should be started immediately after evacuation of Vesicular Mole. Previously it was thought that, the hormones in the contraceptive pill act as growth factors for trophoblastic tissue. For that reason, use of the contraceptive pill and hormone-replacement therapy should be avoided following evacuation of a molar pregnancy until the hCG value has normalized. This does not hold true anymore, as it is proved that OC's does not alter the pattern of hCG regression. After completion of documented remission for 12 months, women who desire pregnancy may discontinue contraception, and can plan for next pregnancy.

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