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Molar pregnancy (mechanism of disease)

This is a flowchart on molar pregnancy, covering the etiology, pathophysiology, manifestations, and complications of complete and partial moles. ADDITIONAL TAGS: The placental-maternal interface swells with water and is destroyed Overgrowth of placental- maternal interface Hydropic degeneration of chorionic villi Risk factors / SDOH Cell / tissue damage Structural factors Molar pregnancy Medicine / iatrogenic Infectious / microbial Biochem / metabolic Immunology / inflammation Signs / symptoms Tests / imaging / labs Environmental / toxin Reproductive pathology Growth / neoplastic Pathophysiology Etiology Manifestations Fertilization of an empty egg Haploid chromosomes of the sperm are duplicated Fertilization of a normal egg (haploid) with two sperm (each haploid) Complete mole: trophoblastic tissue without fetal or embryonic parts Partial mole: trophoblastic tissue containing fetal or embryonic parts Rare: simultaneous fertilization of empty egg by two sperms (each haploid) Fetal karyotypes: 46XX 46XY Fetal karyotypes: 69XXX, 69XXY, 69XYY Prior molar pregnancy History of miscarriage Age 15 and 35 years Uniparental disomy Triploidy Proliferation of cytotrophoblasts and syncytiotrophoblasts Death of the embryo Pelvic tenderness First trimester vaginal bleeding Symptoms milder in partial moles Passage of vesicles, may resembles bunch of grapes Transvaginal US: echogenic mass interspersed with many hypoechogenic cystic spaces that represent hydropic villi; “swiss cheese”, “honeycomb”, “bunch of grapes”, “snowstorm” Transvaginal ultrasound: +/- fetal parts, +/- fetal heart tones, ↑ placental thickness ↑↑ β-hCG (100,000 mIU/mL); complete partial Preeclampsia Hyperemesis gravidarum hCG resembles LH hCG resembles TSH Ovarian theca lutein cysts: tender, bilateral, large, cystic, adnexal masses Hyperthyroidism Trophoblasts invade the myometrium ↑ risk of bleeding Hematogenous spread Invasive mole Malignant transformation of trophoblastic tissue Choriocarcinoma Brain → seizures Lungs → dyspnea, hemoptysis Vagina → Vascular lesions Postpartum bleeding Inadequate uterine regression after delivery Complications: gestational trophoblastic neoplasia