CASE REPORT
Rare Presentation of Partial Hydatiform Mole and its Unusual Management Shikha Singh*, Rekha Rani**, Saroj Singh**, Chetali†, Krishna Singh‡, Tulika#
ABSTRACT Molar pregnancy with no foetal tissue except foetal membrane is very rare presentation. In this article we report a rare case of partial hydatiform mole pregnancy in which patient presented with three months amenorrhoea with bleeding per vaginum for three days on ultrasonography, there was a picture of partial hydatiform mole with a compact mass suspecting of placenta with no foetus. This patient plant for expulsion of tissue, a different management of partial hydatiform mole pregnancy. After expulsion her histopathological report shows a partial hydatiform mole with placenta with foetal membrane and extensive haemorrhage. Key words: Hydatiform mole, gestational trophoblastic diseases
G
estational trophoblastic diseases encompasses a spectrum of proliferative abnormalities of trophoblastics associated with pregnancy. Molar pregnancy is an abnormal form of pregnancy, wherein a nonviable fertilized egg implants in the uterus, and thereby converts normal pregnancy processes into pathological ones. It is characterized by the presence of hydatiform mole (or hydatid mole, mola hydatidosa). Molar pregnancies are categorized into partial and complete mole.
There is wide range of geographical and ethnic variation of the prevalence of the conditions. The molar pregnancy is common in oriental countries-Philippines, Indonesia, Japan, India, Central and Latin America and Africa. The highest incidence is in Philippines being one in 80 pregnancies and lowest in European countries one in 752 and USA being about one in 2,000. The incidence in India is about one in 400.
A complete mole is caused by a single sperm combining with an egg, which has lost its DNA (the sperm then reduplicates forming a ‘complete’ 46 chromosome set) the genotype is typically 46XX. In contrast a partial mole occurs when an egg is fertilized by two sperm or by one sperm, which reduplicates itself yielding the genotypes of 69XXY (triploid) or 92, XXXY (quadriploid).
Mrs. A, 28-year-old, G5P4L2AO with previous four normal vaginal delivery conducted at home and last childbirth 2½ years back, presented in our OPD on 1/7/11 with chief complaints of amenorrhea for 3½ months and bleeding per vaginum for three days and dizziness for three days. She had a ultrasound done from outside, which showed a compact large heterogeneous mass 22 ×12 cm with numerous cyst like structure completely filling the uterine cavity.
*Assistant Professor **Lecturer ***Professor and Head Dept. of Obstetrics and Gynaecology † Asstt. Professor, Dept. of Pathology ‡ PG Student III year Dept. of Obstetrics and Gynaecology # PG Student III year Dept. of Pathology SN Medical College, Agra Address for correspondence Dr Shikha Singh Assistant Professor Dept. of Obstetrics and Gynaecology SN Medical College, Agra E-mail: drshikhasingh.shikha@gmail.com
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Case Report
On general examination, patient was conscious and thin built, height 150 cm, weight 42 kg, pallor+++, icterus +nt, pedal edema not present, pulse was 110/min and blood pressure was 110/70 mmHg. Examination of respiratory, cardiovascular system revealed no abnormality. Urine pregnancy test was faintly positive. On per abdominal examination uterus was 24-26 weeks size doughy, relaxed and fetal parts not felt nor any fetal movements, external ballotment could not be elicited. On per speculum examination there was slight Asian Journal of Obs and Gynae Practice, Vol. 2, April-June 2013