Molar Pregnancies Overview

Questions and Answers

What is the most common presenting symptom of molar pregnancy?

Abdominal distension due to theca lutein cysts

Hyperthyroidism

Vaginal bleeding (correct)

Excessive uterine enlargement

How has the mean gestation at presentation for molar pregnancy changed from 1965-1975 to 1988-1993?

Remained the same at 16 weeks

Increased from 16 weeks to 20 weeks

Decreased from 20 weeks to 16 weeks

Decreased from 16 weeks to 12 weeks (correct)

Which of the following is NOT a less common presentation of molar pregnancy?

Early-onset pre-eclampsia

Haemoptysis

Vaginal bleeding (correct)

Seizures due to metastatic disease

What trend was observed in the percentage of women presenting with only an abnormal ultrasound result between 1996 and 2006?

Increased from 1% to 12% Signup and view all the answers

What condition can result from theca lutein cysts in the context of molar pregnancy?

Hyperemesis Signup and view all the answers

What is a less common presentation of molar pregnancies?

Excessive uterine enlargement Signup and view all the answers

What is the definitive method for diagnosing a molar pregnancy?

Histological examination Signup and view all the answers

What is the preferred method for the removal of a complete molar pregnancy?

Suction curettage Signup and view all the answers

When is medical removal indicated for partial molar pregnancies?

When suction curettage cannot be used due to size of fetal parts Signup and view all the answers

Which of the following is NOT a recognized less common presentation of molar pregnancies?

Increased heart rate Signup and view all the answers

What may be used during suction curettage to minimize complications?

Ultrasound guidance Signup and view all the answers

Which complication can occur due to metastatic disease in relation to molar pregnancies?

Hemoptysis Signup and view all the answers

What condition is characterized by abdominal distension due to theca lutein cysts in the context of molar pregnancies?

Gestational trophoblastic disease Signup and view all the answers

What is the incidence of GTD in women from Asia compared to non-Asian women?

1 in 752 for non-Asian women Signup and view all the answers

At what ages is the incidence of GTD the highest?

Less than 15 years and over 50 years Signup and view all the answers

What is the estimated incidence of GTN after a live birth?

1 in 50,000 Signup and view all the answers

How often might a consultant obstetrician deal with a new case of GTD?

One new case every 2 years Signup and view all the answers

What is the cure rate of the effective registration and treatment program for GTN?

98-100% Signup and view all the answers

What percentage of chemotherapy cases occur after a partial molar pregnancy?

0.5-1.0% Signup and view all the answers

Which statement about ongoing management from GTD centers is accurate?

Outcomes are better with ongoing management. Signup and view all the answers

What databases were searched to develop the guidelines for GTD?

Cochrane Library, EMBASE, MEDLINE Signup and view all the answers

What is the follow-up procedure if hCG has not reverted to normal within 56 days after a complete molar pregnancy?

Follow-up for 6 months from normalization of hCG level. Signup and view all the answers

Which group of women is no longer required to have hCG measured after subsequent pregnancy events?

Women who have not received chemotherapy for a prior molar pregnancy. Signup and view all the answers

What is the primary treatment for women with GTN?

Single-agent or multi-agent chemotherapy. Signup and view all the answers

What does the FIGO 2000 scoring system reflect?

The risk of developing GTN based on clinical assessment. Signup and view all the answers

Which statement is true regarding PSTT and ETT?

They may be treated with surgery due to low sensitivity to chemotherapy. Signup and view all the answers

What is the concluding criterion for follow-up in partial molar pregnancy?

After hCG returns to normal on two samples at least 4 weeks apart. Signup and view all the answers

What is the incidence rate of GTD in subsequent pregnancies for women who have not received prior chemotherapy for molar pregnancies?

1:4011 Signup and view all the answers

Which treatment regimen is given to women with a FIGO score of 6 or less?

Single-agent methotrexate and folinic acid therapy. Signup and view all the answers

What percentage of molar pregnancies are identified correctly before 14 weeks of gestation?

35-40% Signup and view all the answers

What is a common ultrasound feature of a complete molar pregnancy after 8 weeks of gestation?

Thickened cystic appearance of villous tissue Signup and view all the answers

What is the positive predictive value for a partial molar pregnancy?

20% Signup and view all the answers

Which condition is associated with ultrasound findings of delayed miscarriage or anembryonic pregnancy?

Complete molar pregnancy Signup and view all the answers

What ultrasound feature suggests a partial molar pregnancy?

Cystic changes within the decidual reaction Signup and view all the answers

What is the reasonable sensitivity for diagnosing a complete mole via ultrasound?

95% Signup and view all the answers

What is the reported incidence of unrecognized molar pregnancies after surgical removal of pregnancy tissue?

2.7% Signup and view all the answers

What suggests an increased diagnosis rate of molar pregnancies with advancing gestational age beyond 14 weeks?

Lower diagnosis rate before 14 weeks Signup and view all the answers

Study Notes

Molar Pregnancy Presentations

Less common symptoms include hyperemesis, excessive uterine enlargement, hyperthyroidism, early-onset pre-eclampsia, and abdominal distension from theca lutein cysts.
Rarely, women may experience haemoptysis or seizures indicating metastatic disease affecting lungs or brain.
Vaginal bleeding, the most prevalent symptom, occurs in 60% of presentations.

Diagnosis of Molar Pregnancy

Definitive diagnosis is established through histological examination.
Ultrasound plays a crucial role in early diagnosis, with a reduction in mean gestation at presentation over the decades.

Treatment for Molar Pregnancy

Suction curettage is the preferred method for removing complete molar pregnancies.
Ultrasound guidance may reduce perforation risk and improve tissue removal during curettage.
Medical removal is an alternative for partial molar pregnancies when fetal parts are too large for suction curettage.

Incidence and Ethnic Variations

Higher incidence of gestational trophoblastic disease (GTD) in women from Asia compared to non-Asian women, at rates of 1 in 387 versus 1 in 752 live births respectively.
GTD incidence is higher in the extremes of age: 1 in 500 pregnancies for women under 15 and 1 in 8 for those over 50.
There may be underreporting of partial moles impacting true incidence rates.

Follow-up and Management

A structured registration and treatment program in the UK results in a cure rate of 98–100% for GTN.
Follow-up post-complete molar pregnancy varies based on hCG normalization: if achieved in 56 days, follow-up is for 6 months; if not, 6 months after normalization.
For partial molar pregnancy, follow-up ends after two normal hCG samples taken at least 4 weeks apart.

Treatment for Gestational Trophoblastic Neoplasia (GTN)

GTN can be treated with single-agent or multi-agent chemotherapy based on the FIGO 2000 scoring system.
PSTT and ETT, rare variants of GTN, are primarily treated surgically due to lower chemotherapy sensitivity.
Women with a FIGO score of 6 or lower are treated with single-agent intramuscular methotrexate along with folinic acid.

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Description

Explore the less common presentations of molar pregnancies, including symptoms like hyperemesis and hyperthyroidism. This quiz delves into the unique clinical manifestations and potential complications associated with this condition. Test your understanding of these rare outcomes.