Hydatidiform mole can be classified into two basic types: complete (MHC) and partial or incomplete (MHP). These forms are differentiated through histopathological and karyotype aspects. In MHC, there is an absence of a fetus, while in MHP there is the presence of the embryo, which is usually unviable or has several malformations.
In MHC , as previously mentioned, there is no presence of the fetus, the cord and the membranes. Analyzing the karyotype, it is possible to observe that fertilization occurs in a secondary oocyte, which has an absent or inactive nucleus, by a 23X sperm, which has duplicated its chromosomes, or by two sperm. There is, in this case, a uniparental disomy, in which all genes have paternal origin. This chromosomal abnormality leads to early loss of the embryo and causes a proliferation of trophoblastic tissue. In 90% of MHC cases, there is a female karyotype.
In MHP, the presence of several small hydropic vesicles is observed, in addition to the trophoblastic tissue and the fetus. In this type of mole, cases of chromosomal anomalies, such as trisomies, triploidies and tetraploids, are common. This is because MHP is the result of fertilization of a normal secondary oocyte by two sperm or a diploid sperm. This type of hydatidiform mole rarely evolves into malignant forms.
Women who have the disease usually have vaginal bleeding , which may or may not be accompanied by cramping. This symptom usually appears between the 4th and 16th week of amenorrhea. Another common feature of the mole is the volume of the uterus , which can be greater than the gestational age or smaller, depending on the form of the disease. In addition to these symptoms, we can highlight hyperemesis and early toxemia.
It is believed that the disease occurs in greater numbers in women over 40 years of age, in adolescents and in those who have already had a miscarriage. Early diagnosis is relatively complicated, since initially imaging tests are not accurate and symptoms are common to other pathologies. Histopathology is still the best method for diagnosing hydatidiform moles.
After confirmation of the disease, it is necessary to perform the emptying of the uterine cavity. Emptying using the vacuum aspiration technique and subsequent curettage is recommended to ensure removal of all material.
After emptying, it is essential that the patient continue medical follow-up, mainly due to the malignant potential of the disease. Dosage of hCG should be done weekly until three consecutive negative results are obtained. Thereafter, dosages can be taken monthly for a period of six months to a year. A new pregnancy is allowed after evaluation of at least six consecutive months of negative hCG.