Molar pregnancy is rare disorder of uterus in which fertilized egg develops into bunch of grapes called molar pregnancy and it has potential to be malignant.
It is a very grave but rare and life threatening clinical situation of the pregnant uterus and is also called HYDATIDIFORM MOLE. It has two types’@ complete mole and @incomplete mole. These are based on gross morphology and histopathology as well as karyotype. It is an abnormal condition of the placenta where both degenerative and proliferative changes occur in young chorionic villi. These result in the formation of cysts of various size and shape. Itis in a way benign neoplasm of chorion with malignant potential. Its occurrence and prevalence is highest in teenage pregnancies and in that woman over the age of 40 one important cryptogenic abnormality of this clinical condition is that the molar chromosomes are entirely derived from the father.
It seems that everything is going well and uterus increases in size as if the embrown is growing. But soon it turns out to be false conception about pregnancy. Instead actually it is not embryo that is growing in size but the neoplasm is replacing the true embryo. Ultimately it turns to be tumor and had to be immediately operated upon.
Molar pregnancy is defect of fertilization process the egg released by ovary is entirely devoid of DNA or it may be termed as empty egg. The genetic structure of sperm of father contains 23+ x after fertilization. The chromosomes duplicate So the karyotype is 46=xx It is an abnormal fertilization in which no egg from mother’s side i.e. 23+x participates in the fertilization process. The two chromosomes in the fertilized egg i.e. molar chromosomes are from father only.
Pathology of hyadatid cyst
It is a disease of the chorion. When theembryo fails to grow, its abnormal mitotic growth goes on than it results in clusters of cysts of varying size .There is no evidence of embryo or amniotic sac. The death of the ovum or the embryo caused this abnormal cyst to grow. Histological section of Hydatidiform mole through microscope shows hydropic degeneration of the vullus stroma with total absence of blood vessels trophoblastic proliferation. The complete molar karyotype is 46xx
Occurrence and incidence
There is marked geographical and ethnic variation in the prevalence of this clinical condition. The molar pregnancy is very common in china, Philippines, Indonesia, Japan India Africa and Latin America. Its highest rate of occurrence is in Philippines. Here one out of 80 pregnancies is of molar pregnancy and it is lowest in European countries. Here its ratio is one to two hindered. The ratio in India is one to four hundred. Why are these ethnic and socio-geographical factors contributing so widely to this clinical condition the gynecological science is yet to discover?
Clinical signs and symptoms
• Generally the history of 8-12 weeks of amenorrhea is present.
• In 90%cases bleeding is the commonest occurrence and presentation
• Lower abdominal pain of varying degree
• Sickly and anemic appeared of the patient without any definite traceable cause.
• Vomiting becomes more acute and excessive.
• Thryrotoxic feature of palpitations anxiety, tachycardia may be present.
• Expulsion of grape like vesicles per vaginum is diagnostic of vesicular mole.