New insights in the pathophysiology of complete hydatidiform mole. (February 2018)

• Record Type: Journal Article
• Authors: Jauniaux, Eric; Memtsa, Maria; Johns, Jemma; Ross, Jackie A.; Jurkovic, Davor
• Is Part Of: Placenta. Volume 62(2018)
• Page Start: 28
• Page End: 33
• Publication Date: 2018-02
• Subjects: Complete mole -- Hydatidiform mole -- Ultrasound -- First trimester -- Miscarriage -- Prenatal diagnosis; Placenta -- Periodicals; Reproduction -- Periodicals; Placenta -- Periodicals; Placenta -- Périodiques; Reproduction -- Périodiques; 612.63
• DOI: 10.1016/j.placenta.2017.12.008
• Languages: English
• ISSNs: 0143-4004

Abstract

Abstract: Objective: The majority of complete hydatidiform moles (CHM) are detected on ultrasound examination by the end of the first trimester when they present as multiple sonolucent cysts. To better understand the pathophysiology of this unique placental pathology and improve its prenatal diagnosis and management we have reviewed the ultrasound features of CHM before the appearance of cystic changes. Study design: We searched our database to identify all women diagnosed with a complete hydatidiform mole confirmed by histopathology who had an ultrasound examination before 9 weeks' gestation. We reviewed their ultrasound reports and all the corresponding images. Results: The study group included 39 women with a positive pregnancy test and vaginal bleeding, 36 of whom had at least two ultrasound examinations before 9 weeks' gestation. At the first scan (mean gestation age 7 + 1 weeks; SD 1.1), 29 out 39 (74.4%) of CHM presented as a heterogeneous hyperechogenic mass with or without gestational sac and the remaining ten (25.6%) cases as a regular 4-week gestational sac. Cystic molar changes became apparent from the end of the second month of gestation. Conclusion: The development of a CHM follows a well-defined pattern starting with a macroscopically normal gestation sac at 4 weeks, which transforms into a polypoid mass between 5 and 7 weeks of gestation. The hydropic changes of the villous tissue is progressive and rarely visible in utero on ultrasound before 8 weeks of gestation. These findings should allow an earlier diagnosis and assist in the management counselling of women with CHM. Highlights: The development of a complete hydatidiform moles follows a well-defined pattern. During the first stage (4–5 weeks) they present as a morphologically normal sac. The second stage (6–7 weeks) is characterized by the development of polypoid masses. The third stage (from 8 weeks) is associated with characteristic villous hydrops. Each stage has specific ultrasound features essential to early prenatal diagnosis.