Uterine height more than corresponding gestational age with complains of vomiting and pervaginal bleeding favors the diagnosis of?
Correct Answer: H. mole
Description: Ans-A H. mole. (Ref Dutta Obst.7th/pg. 192)Hydatidiform mole/vesicular mole:# Abnormal condition of ovum with partly degeneration and party hyperplastic changes in young chronic villi.# It is benign neoplasia of chronic with malignant potential.# Highest incidence in Philippines/ # In India 1 in 400.# Can be complete or incomplete.# Complete moles have 46XX Karyotype, molar chromosomes derived entirely from Father (androgenous).G# Vesicle fluid is interstitial fluid rich in HCG# There is no trace of embryo or amniotic sac.# Vaginal bleeding commonest presentation (90%).# Expulsion of "grape-like" vesicles per vaginum diagnostic.# Features of pre-eclampsia present in about 50%.# Size of uterus more than expected for period of ammenorrhea in 70%, corresponds with period of ammenorrhea in 20% and smaller in 10%.# Unilateral or bilateral enlargement of ovary# (Theca lutein Cyst) in 25-50% of cases.2# Histological section of hydatidiform mole showing hydropic degeneration of the villus stroma with absence of blood vessels and trophoblastic proliferation.# USG - 'Snow storm' appearance.2# HCG in urine between 1 in 200 to 1 in 500 beyond 100 days highly suggestive.# Complications of hydatidiform mole:# Immediate: 1. Haemorrhage and shock# 2. Sepsis# 3. Perforation of the uterus# 4. Preeclampsia# 5. Acute pulmonary insufficiency# 6. Coagulation failure# Late: Choriocarcinoma# Rx:- Rx of choice is suction evacuation.Evacuation of uterus is to be done as soon as diagnosis of vesicular mole is made. The preferred method is suction evacuation supplemented by oxytocin drip. (20 units in 500 ml 5% dextrose at rate of 30 drops per minute).
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