Uterine bleeding, beginning at 6–16 weeks, is observed in most instances. In some cases, the uterus is larger than would be expected in a normal pregnancy of the same duration. Excessive nausea and vomiting may occur. Bilaterally enlarged cystic ovaries are sometimes palpable (eFigure 19–6). They are the result of ovarian hyperstimulation due to excess beta-hCG.
Trophoblastic disease. Transverse scan of the pelvis with a hydatidiform mole (M) and ovarian theca-lutein cysts (arrowheads). (Reproduced, with permission, from Krebs CA, Giyanani VL, Eisenberg RL. Ultrasound Atlas of Disease Processes. Originally published by Appleton & Lange. Copyright © 1993 by The McGraw-Hill Companies, Inc.)
Preeclampsia-eclampsia may develop during the second trimester of an untreated molar pregnancy, but this is unusual because most are diagnosed early.
Choriocarcinoma may be manifested by continued or recurrent uterine bleeding after evacuation of a mole or following delivery, abortion, or ectopic pregnancy. The presence of an ulcerative vaginal tumor, pelvic mass, or distant metastases may be the presenting manifestation.
Hydatidiform moles are generally characterized by high serum beta-hCG values, which can range from high normal to the millions. Levels are higher with complete moles than with partial moles. Serum beta-hCG values, if extremely high, can assist in making the diagnosis, but they are more helpful in managing response to treatment. Hemoglobin/hematocrit, creatinine, blood type, liver biochemical tests, and thyroid function tests should also be measured. High beta-hCG levels can cause the release of thyroid hormone, and rarely, symptoms of hyperthyroidism. Patients with hyperthyroidism may require beta-blocker therapy until the mole has been evacuated.
The preoperative diagnosis of hydatidiform mole is confirmed by ultrasound (eFigure 19–7). Placental vesicles can be easily seen on transvaginal ultrasound. A preoperative chest film is indicated to rule out pulmonary metastases of the trophoblast.
Trophoblastic disease (mole). A: Longitudinal image through the uterus demonstrates a large mass (arrows) with multiple cystic components filling the uterine cavity. B: Endovaginal scan of the same patient better demonstrates the cystic areas. C: Color Doppler flow imaging of the uterus demonstrates the marked vascularity of this mass. (Used, with permission, from Peter W. Callen, MD.)