Molar pregnancy

Hydatidiform mole (Hydatidiform mole)

1) Disease Description (Causes and Symptoms)

• Definition and pathophysiology: Unlike a normal pregnancy, this pregnancy-related tumor results from abnormal fertilization, causing excessive proliferation of chorionic (placental) tissue and hydropic degeneration of the chorionic villi, which form small fluid-filled sacs (vesicles). Based on the genetic composition, it is divided into a complete mole (usually diploid and typically of paternal origin) and a partial mole (usually triploid). In most cases, the fetus does not develop or is lost at an early stage.
• Causes / risk factors: The exact cause is unknown, but the following increase the risk — extreme maternal age (adolescence or age 35 and older), a history of a previous hydatidiform mole, and a history of recurrent miscarriage or infertility. Some epidemiological studies have suggested an association with nutrition (for example, vitamin A deficiency).
• Main symptoms: Abnormal vaginal bleeding (the most common), a uterus larger than expected for the gestational age (markedly enlarged uterus), severe morning sickness/vomiting (hyperemesis gravidarum), pelvic or abdominal pain, preeclampsia in early pregnancy (early-onset preeclampsia), theca-lutein cysts of the ovaries (due to excessive villous stimulation), and, rarely, symptoms of hyperthyroidism (cross-stimulation by β-hCG).

2) Treatment Methods and Precautions

• Summary of diagnostic tests: Transvaginal ultrasound (multiple small cystic lesions within the uterus, with a “bunch of grapes” appearance), elevated quantitative β-hCG (excessively high compared with the same gestational age), and pathological examination of removed tissue (definitive diagnosis).
• Standard treatment:
  • Removal of intrauterine contents: Suction dilation and curettage is the first-line treatment (when fertility preservation is desired).
  • Hysterectomy may be considered after menopause or in older patients who have completed childbearing.
  • If persistent β-hCG elevation after tissue examination or an invasive lesion is diagnosed as gestational trophoblastic neoplasia (GTN), chemotherapy may be required (single-agent therapy: methotrexate or actinomycin D, or combination chemotherapy).
  • Prophylactic chemotherapy: This may be considered in some situations involving high risk (for example, very high β-hCG or a high risk of extensive hematogenous metastasis), but routine use is not recommended.
  • Other: Rho(D) immune globulin should be administered after surgery to Rh-negative mothers (the same principle as for miscarriage or delivery). Supportive treatment for complications such as bleeding and infection.
• Follow-up:
  • Quantitative β-hCG should be tested regularly after surgery and monitored until it returns to normal (generally with weekly testing), followed by additional follow-up for the recommended period (usually several months) even after it becomes undetectable.
  • Avoidance of pregnancy is recommended during the follow-up period (see details below).
• Complications and warnings:
  • Persistent gestational trophoblastic disease (invasive hydatidiform mole), choriocarcinoma (often treatable), and possible metastasis to the lungs, brain, and other organs.
  • If treatment is delayed, there is a risk of hemorrhagic fainting and symptoms caused by systemic metastasis.

3) Outpatient Visit Checkpoints (Including Preparation Materials and Example Questions)

• Documents/materials to bring:
  • A list of all medications currently being taken (including prescription drugs and supplements)
  • Medical history (especially previous hydatidiform mole, miscarriage, or infertility treatment)
  • Recent gynecological examination records (ultrasound images and β-hCG test results)
  • A record of current symptoms (amount and onset of bleeding, nature of pain, frequency of vomiting, etc.)
• Information to measure or record:
  • The first day of the last menstrual period (or the timing when the pregnancy was confirmed)
  • Body temperature and blood pressure (if possible at home)
• Situations that should be reported immediately to the nurse or doctor during the outpatient visit:
  • Heavy bleeding (severe vaginal bleeding or symptoms of fainting), difficulty breathing, or severe headache/visual disturbances (symptoms suggestive of brain metastasis)
• Examples of questions to prepare (phrases the patient can use directly):
  • “How should I interpret the trend in my recently measured β-hCG levels?”
  • “Is there anything I need to prepare before the surgery (suction curettage)?”
  • “What symptoms should I watch for during the first few weeks after surgery?”

4) Examples of General Questions to Ask the Doctor

• “What is the standard treatment in my case, and are there alternative options?”
• “How long does it usually take for β-hCG to return to normal? What is the schedule for follow-up testing?”
• “How will the treatment affect my fertility (ability to become pregnant)?”
• “If chemotherapy is needed, which drugs will be used and what are their side effects?”
• “What is the risk of recurrence, and how would it be managed if it recurs?”

5) Examples of Disease-Specific Questions

• “Do my pathology results show a complete mole or a partial mole? How does the prognosis differ by type?”
• “How long should β-hCG be monitored, and when can I start planning a pregnancy again?”

Summary of Additional Precautions

• It is important to avoid pregnancy during the follow-up period (the generally recommended period: contraception is recommended for a certain period even after β-hCG has returned to normal, usually between 6 months and 1 year—follow your doctor’s instructions).
• Be sure to follow the schedule for regular β-hCG testing and gynecological follow-up. Seek medical attention immediately for abnormal findings such as persistent bleeding, chest pain, difficulty breathing, or neurological symptoms.
• Overall prognosis is generally favorable with appropriate treatment and follow-up, and many patients can have a normal pregnancy afterward.