Obstetrics and Gynecology - A.M. Gromova 2000

Malignant neoplasms of the female reproductive organs
Trophoblastic diseases
Hydatidiform mole

Hydatidiform Mole can present as either complete trophoblastic involvement with resorption of the embryo, or partial involvement, where vesicles ranging from 1 mm to 4 cm in diameter form alongside a preserved fetus.

A destructive form of hydatidiform mole is also distinguished, in which high proteolytic activity leads to the destruction of the decidua, uterine wall, and Blood Vessels, mimicking tumor growth. Occasionally, such damage extends to the serosal layer and results in intraperitoneal Hemorrhage.

Hydatidiform mole is more frequently observed in women of middle reproductive age. This type of Pregnancy is accompanied by prominent signs of gestosis (early and sometimes late), along with colostrum discharge from the nipples.

Clinical manifestations of the pathology include symptoms of threatened Miscarriage in early or late terms, and potential bloody vaginal discharge containing vesicles. Gynecological examination reveals a significantly enlarged Uterus that exceeds the expected gestational age, as well as lutein cysts of the Ovaries (a pathognomonic sign). Sometimes patients are admitted to the hospital with signs of intraperitoneal hemorrhage (destructive hydatidiform mole).

Laboratory tests reveal high concentrations of human chorionic gonadotropin and estrogens.

The primary Treatment for hydatidiform mole is careful evacuation of the uterine cavity (preferably by vacuum-escochleation). Additionally, hemostatic, uterotonic agents and an ice pack to the lower abdomen are prescribed. In cases of a significant risk of uterine perforation during curettage, the goal is not to completely empty the uterus in one session; instead, a second Procedure is performed 2-3 days later.

In cases of invasive mole (destructive hydatidiform mole), uterine evacuation carries a high risk of perforation. Under such circumstances, laparotomy and Hysterectomy are performed.

Chemotherapy is indicated for women who exhibit persistent uterine subinvolution, ongoing vaginal bleeding, and persistently elevated levels of human chorionic gonadotropin following uterine curettage. Regimens typically include vinblastine, methotrexate, mercaptopurine, rubomycin, and dactinomycin.

Due to the risk of developing Choriocarcinoma, patients remain under clinical dispensarization (follow-up) for three years after completing treatment. During the first year, monthly examinations including human chorionic gonadotropin testing are required, followed by check-ups every three months in the subsequent years. If a positive test is detected, the patient is hospitalized for a thorough evaluation, diagnostic confirmation, and treatment. Subsequent pregnancy is generally advised only after three years.