Hydatidiform Mole – When Pregnancy Goes Wrong

G’day Team,

Today I thought I’d have a chat about what has to be one of the most horrifying and fascinating conditions known to science. This error of reproduction is known as a Hydatidiform mole and is a growth caused, in essence, by an error in normal fertilization of an egg.

What Is It?

In a normal pregnancy a sperm, which carries either an X or Y chromosomes, fertilizes an egg which carries an X chromosome. This egg divides and becomes an embryo, which moves to and implants in the uterine wall and continues to develop into a fetus and finally a baby.
Assuming that nothing goes wrong! A Hydatidiform mole is created when two sperm both fertilize a single egg, creating a growth that want’s to form a placenta and fetus, but doesn’t have the biological coding to do it. There are two main types of Hydatidiform mole…

A complete mole
-Occurs when 2 sperm and an egg with no genetic material (diploid)
-No embryo or fetus is formed at any stage
-May become locally invasive, but have no metastatic potential
-2% will progress to Choriocarcinoma
-Very high levels of bHCG

A partial mole
Occurs when 2 sperm and an egg with one set of genetic material (triploid)
The embryo will develop into a fetus, but this fetus will not be viable.
Rarely develops into choriocarcinoma
Still has high levels of bHCG but not AS high

Other forms
There have been cases of biparental moles noted in literature, but it is a very rare disease and often results from a failure in maternal imprinting.

What Are Doctors Looking For?

So these are out two types of hydatiform mole. And as you’ll notice above there are two big differences that any treating doctor will want to pay particular attention to.

1. Complete moles are more likely to progress to choriocarcinoma
2. Complete moles have higher levels of bHCG

Choriocarcinoma
Choriocarcinoma is a bit of a strange cancer because there are two ways to get it. In essence, it's a cancer of germ cells, or of cells that are designed for reproduction (think the precursors to eggs and sperm). It’s most often seen in women where it arises from placental cells (especially in complete molar pregnancies, as per above) but it may also occur in both men and women arising from the cells of the testis and ovaries respectively
Choriocarcinoma has a BETTER outcome (prognosis) if it’s from a placenta, and worse if it develops in the testis or ovaries. Choriocarcinoma are extremely rare in normal pregnancies (1/50,000), and 50% are seen after complete molar pregnancies with another 30% seen after abortions.

Beta-HCG (bHCG)
Beta HCG is the hormone of pregnancy! It’s the hormone that is tested for by your standard pee-on-a-stick pregnancy test and it’s the hormone that stops you from entering a new menstrual cycle when there’s a bun in the oven.
But the high levels of bHCG in Complete Molar Pregnancies mean that women will experience exaggerated symptoms of pregnancy, which is not only not nice, but can be quite dangerous.

How Does It Present

How do we know if a patient has a Hydatidiform mole? We can look for some of the follwoing!

1. A rapidly progressing pregnancy with the mole gaining weight faster than a normally growing fetus would.
2. Exaggerated symptoms of pregnancy, especially in complete moles.
3. In some cases vaginal discharge of a brown liquid may also be noted, however this is more likely to indicate progression to choriocarcinoma.

But please! This does not mean every pregnancy in which the mother doesn’t feel well is a hydatiform mole. It’s always better to be safe than sorry, but undue panic isn’t good for anyone. Remember Pre-eclampsia and hyperemesis gravidarum are much more common condition which will also make a pregnant women feel horrible.

Who Gets It?

Any women who falls pregnant can get a hydatiform mole, but there are certain age groups that are at a higher risk. Notably:
Young teens: un-quantified increased risk
Women over 35: 2-fold increase risk
Women over 40: 5-10 fold increase risk

Prognosis

Good news! Because of early diagnosis and our great treatment methods, the mortality rate is almost 0%. Even women who progress to choriocarcinoma have almost a 100% cure rate.

Thanks For Reading

Thanks team, I hope you enjoyed the post. If you've any questions or comments please feel to leave them below. To read a little more about me read my intro

Please follow, upvote and resteem :D

-tfc

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References

(1) Hydatiform Mole - Medscape
(2) Robins Basic Pathology
(3) Treatment for Gestational Trophoblastic Disease
(4) Molar pregnancy – Up to date
Picture 1) Complete Mole 1
Picture 2) Complete Mole 2
Picture 3) Partial Mole
Picture 4) Choriocarcinoma