MOLAR ABORTION (HYDATIDIFORM MOLE)

Hydatidiform mole should be managed carefully because of its potential to progress to choriocarcinoma.

Clinical Features

  • A hydatidiform mole usually presents as a threatened or incomplete abortion.
  • In the threatened stage, before the cervix opens, the diagnosis of hydatidiform mole is suspected if bleeding does not settle within a week of bed rest.
  • The uterine size is larger than gestational age and foetal parts are not palpable. Foetal movements are not felt at gestation 18–20 weeks and beyond.
  • Features of hyperemesis gravidarum, nausea, vomiting, and ptyalism are still present and severe after 3 months.
  • When the cervix opens, passage of typical grape-like vesicles confirms the diagnosis.
  • Bleeding may be very heavy when a mole aborts spontaneously.

Investigations

  • Positive pregnancy test in dilutions after 12 weeks gestation
  • Confirmation is by ultrasound

Management

  • Treat shock with IV fluids or blood as necessary.
  • Put up oxytocin drip (20 IU in 500ml litre of normal saline or 5% dextrose at 20 drops per minute) for 4 hours or until drip is over and give IV antibiotics crystalline penicillin 3 mega units 6 hourly, gentamycin 80mg 8 hourly, and PO
    ibuprofen 400mg TDS.
  • Evacuate the mole with suction curettage; after evacuation continue oxytocin drip once the patient has stabilized. discharge home on oral antibiotics (doxycycline 100mg 12 hourly and PO metronidazole 400mg 8 hourly for 5 days) and ibuprofen 400mg 8 hourly for 5 days, and advise patient to return for admission for sharp curettage after 2 weeks.
  • Repeat sharp curettage to make sure all remains of the mole have been evacuated and send tissues for histology.
  • Provide reliable contraception for 1 year: combined pill, e.g., levonorgestrel 150μg thinylestradiol, 30μg (microgynon or nordette) once daily for 3 weeks with breaks of 1 week in between is the best choice. Follow up monthly for pelvic examination and repeat pregnancy tests.