Molar Pregnancy

What is molar pregnancy?
Molar pregnancy is a rare complication of molar sarcinii.Sarcina is due to disturbances during the process of fertilization and is characterized by abnormal cells that

form placenta.Sarcina molar, mole hidatiforma sometimes called, is part of a group of diseases called trophoblastic disease gestational. Gestational trophoblastic disease is characterized by a set of tumors: trophoblastic proliferation (peripheral cell layer of the egg to be behind the placenta), excessive production of hCG and senibilitate to chemotherapy. They are usually benign (not cancerous), although it can spread outside the uterus, they are curable. In molar pregnancy, placental villi villi turn into blisters (cysts abnormal) giving a cluster of grapes appearance placenta. Embryo does not develop at all or is malformed and can not survive. Approximately one pregnancy in every 1,000 pregnancies is a molar pregnancy.

What kind of mole?
In a normal pregnancy, the fertilized egg contains 23 chromosomes from the father and 23 chromosomes from the mother. In complete molar pregnancy, the fertilized egg has chromosomes from mom and dad are from duplicate chromosomes, so the fertilized egg will have two copies of chromosomes from the father and none from the mother. In this case, there is no embryo, amniotic sac or placental tissue normally. Instead, the placenta forms a mass of cysts resembling a cluster of grapes. These cysts are visible on ultrasound.
The partial molar pregnancy, the fertilized egg has the normal number of chromosomes from the mother (23), but double the chromosomes from the father, so that the fertilized egg has 69 chromosomes instead of 46 (as normal). This can happen when chromosomes from the sperm are duplicated or when two sperm fertilize the same egg. In this case, there are normal placental tissue among the cysts abnormal. In most cases the embryo begins to develop, so there is a fetus or amniotic sac. If the fetus is present, it presents serious birth defects and genetic and can not survive. Extremely rarely a partial molar pregnancy with twins may develop in which a fetus develops cvasinormal, but the second often dies.

What are the risk factors?
1. Age-The risk of complete molar pregnancy steadily increases after age 35. After 40 years of age can increase the risk of five times or more.
2. Race incidents were observed at various different races, so black women have a much higher risk compared with white women.
3. History of mole-Women who have had a molar pregnancy have a 10 times higher risk of having a new mole.
4. History of miscarriage
5. Low protein diet, low protein diet is a risk factor, while beta-carotene-rich regimes (vitaminaA) and fats are considered protective.
6. -Smoking is considered a risk factor compared with nonsmoking women
7. Bivitelina history of twins (two eggs have been fertilized by one sperm cell each)
8. History of viral and parasitic infections (toxoplasmosis)
9. Endocrine diseases - disorders of estrogen, ovulation abnormalities
Immunological 10.Afectiuni
External 11.Factori: radiation and extreme temperatures

What are the clinical manifestations of molar pregnancy?
• Molar Pregnancy symptoms may be manifested by an exaggeration of normal pregnancy: lack of menstruation, the sensitivity and enlargement of the breasts, urinary disorders, morning sickness.
• The most common symptom is vaginal bleeding, especially in the 6 to 16 weeks may be symptomatic sarcina.Aceasta initial quantity is variable (first in small quantities, then gradually rises) may be intermittent (it is intermittent and persists several months can lead to anemia), blood is light vaginal bruna.Sangerarea occur in approximately 20% of normal pregnancies in the first quarter and occurs when a fertilized egg is implanted in the uterine lining. This may break some blood vessels, bleeding is slight, pale.
• vaginal bleeding may be accompanied by removal of molar vesicles (placental tissue fragment containing vesicles rupture is eliminated through the vagina). This symptom is not common.
• Abdominal distention is due marit.Uterul uterus is much larger than it should be compared with age gestationala.Un enlarged uterus is a characteristic sign of molar pregnancy but can also be found enlarged uterus in multiple pregnancy (twins).
Excessive • Nausea and vomiting during the first trimester of pregnancy. These symptoms may be characteristic of preeclampsia, which develops slowly during the first trimester of pregnancy.
• Fatigue is due to anemia (loss occurs due to prolonged blood) or hyperthyroidism (increased secretion of thyroid hormones)
• severe abdominal pain may be due to internal bleeding.
• cramping abdominal or pelvic pain is intermittent and are due to increased uterine volume.
• the baby's heartbeat and movements are not perceptible because baby is now in complete mole and some partial molar pregnancy.
• high blood pressure (hypertension) is a common symptom of preeclampsia preeclampsiei.Sarcina Molar cause during the first trimester or the beginning of the second trimestru.Alte preecalmpsie signs are nausea, vomiting, excessive headache (headache) , dizziness, edema (swelling of the feet).
• Hyperthyroidism can be diagnosed in 25% of molar pregnancy, but is manifest in 2-7% of cases. Signs of hyperthyroidism, fatigue, weight loss, increased heart rate, palpitations (cardiac arrhythmias occur), heat intolerance, excessive sweating, irritability, anxiety (fear), muscle weakness, tremors, etc.. Hyperthyroidism occurs due to excessive secretion of TSH stimulation increases the secretion of thyroid hormones.
• Signs of pulmonary lesions may occur rarely, if the disease spreads to the lungs before being diagnosed. Maybe there shortness of breath, coughing up blood or secretions. Sometimes a few hours after evacuation of molar pregnancy may cause embolization (migration) of fragments of mole in the lungs and is manifested by dyspnea (difficult breathing), increased heart rate and decreased blood pressure (hypotension).
• Rarely are common signs of cardiomyopathy and nephropathy.

What is the evolution of molar pregnancy?
It is important to monitor a mole for about six months after diagnosis and treatment, as even tiny amounts of the mole may grow and spread rapidly, and this can happen, sometimes, several months after treatment. If the level of hCG (human chorionic gonadotropin, peptide hormone produced during pregnancy) begins to rise or remain at a high level you have to go to the doctor.
Invasive mole can sometimes develop after surgery to remove the pregnancy. Invasive mole means that the molar tissue has grown into the muscular layer of the uterus (miometru). The most common symptom of invasive molar pregnancy is continuing or irregular vaginal bleeding after surgery. Invasive molar pregnancy can lead to complications, because once the molar tissue has grown into the muscular layer of the uterus that can migrate (embolize) through the blood to different organs including the lungs, liver and brain. Invasive molar pregnancy can develop after a partial molar pregnancy, but it is more likely to develop after a complete molar pregnancy.
Occasionally, abnormal cells may remain after molar pregnancy is removed. This is called persistent gestational trophoblastic disease. It occurs in 15% of women with complete molar pregnancy and less than 1% of women with partial molar pregnancy. Treatment consists of chemotherapy, treatment that continues until hCG levels return to normal. With prompt and appropriate treatment, nearly 100% of cases are curable (heal) when the disease has not spread outside the uterus. Even in very rare cases in which abnormal cells have spread to other organs, they can be cured. After installation of complete remission (absence of clinical and laboratory signs of disease), it is necessary to monitor the amount of hCG intermittently for life.
In a small number of cases, a complete molar pregnancy can cause coriocarcinomului, an extremely rare form, but the cancer.Coriocarcinomul curable malignant trophoblastic tumor is a fetus, a component of the placenta. The frequency of this disease is 1 in 30,000 pregnancies. 50-75% of coriocarcinoame following a molar pregnancy but can occur after a normal pregnancy, miscarriage or ectopic pregnancy. Clinical manifestations of vaginal bleeding during the following mole evacuation, persistent, causing anemia and pain intensity redusa.Uneori first symptoms may be due to lung metastases at this level.