Molar pregnancy

Molar pregnancy

A molar pregnancy is a gestational trophoblastic disease that grows into a mass in the uterus composed of swollen chorionic villi. These villi grow in clusters that resemble bunches of grapes. Once diagnosed, it should be treated immediately.

Clinical presentation

• Vaginal bleeding

• Uterus larger than expected for gestational age

• Exaggerated pregnancy symptoms (severe nausea and vomiting)

• Vaginal discharge of tissue resembling grapes

• Heavy per vaginal bleeding when the mole aborts spontaneously

Management of molar pregnancy at the dispensary and health centre

• Apply Airway, Breathing, Circulation and Dehydration (ABCD) principles of resuscitation

• Check haemoglobin level

• If the patient is actively bleeding, insert a urinary catheter, establish an IV line, and give 2 litres of Ringer's lactate or normal saline rapidly

Referral

• Resuscitate and refer the patient to a higher-level facility with a nurse escort for appropriate management

Management of molar pregnancy at the hospital

• Apply Airway, Breathing, Circulation and Dehydration (ABCD) principles of resuscitation

• If the patient is actively bleeding or in shock, call for help and mobilize resources

• Check Hb, blood grouping, and cross-matching

• Perform quantitative serum beta-human chorionic gonadotropin (β-hCG)

• Perform abdominal and pelvic ultrasound to confirm the diagnosis (snowstorm appearance)

• Infuse compound sodium lactate (IV) or 0.9% sodium chloride (IV) as needed

• Initiate blood transfusion if indicated

• Perform suction curettage in the operating theatre

• Perform other investigations as appropriate (chest X-ray, renal function tests, liver function tests, and chemistry panel)

Follow-up after molar evacuation

• Check weekly β-hCG until it becomes normal (5–10 mIU/mL) for three consecutive weeks

• Then check monthly β-hCG and pelvic ultrasound for 12 months

• Advise the patient to use effective contraception during follow-up, preferably combined oral contraceptives (COCs)