Laboratory Studies

The following laboratory studies may be used to evaluate patients with suspected hydatidiform mole:

Quantitative beta-hCG levels: hCG levels greater than 100,000 mIU/mL indicate exuberant trophoblastic growth and raise suspicion for a molar pregnancy. However, a molar pregnancy may have a normal hCG level.
Complete blood cell count with platelets: Anemia could be present and coagulopathy could occur.
Clotting function studies: Test clotting function to exclude the development of a coagulopathy or to treat one if discovered.
Liver function tests
Blood urea nitrogen (BUN) and serum creatinine levels
Blood type and Rh factor
Thyroxine level: Although women with molar pregnancies are usually clinically euthyroid, biochemical hyperthyroidism has been reported in 6% of patients with hydatidiform mole diagnosed at 5-9 weeks of gestation and in 28% when the diagnosis is made after 10 weeks' gestation. Patient may present with signs and symptoms of hyperthyroidism. Clinical hyperthyroidism occurs in less than 3% of cases.
Serum inhibin A and activin A levels: Serum inhibin A and activin A have been shown to be 7- to 10-fold higher in molar pregnancies than normal pregnancies at the same gestational age. The fall in inhibin A and activin A after evacuation may prove helpful. ^[38]However, of the readily available markers, serum hCG levels is the standard of care.

Imaging Studies

Ultrasonography is the criterion standard for identifying both complete and partial molar pregnancies. The classic image, using older ultrasonographic technology, is of a snowstorm pattern representing the hydropic chorionic villi. High-resolution ultrasonography shows a complex intrauterine mass containing many small cysts.

Once a molar pregnancy is diagnosed, a baseline chest radiograph should be taken. The lungs are a primary site of metastasis for malignant trophoblastic tumors (see the Medscape Drugs & Disease article Gestational Trophoblastic Neoplasia).

Complete mole

Complete hydatidiform moles have edematous placental villi, hyperplasia of the trophoblasts, and lack or scarcity of fetal blood vessels. Their chromosomal complement is 46,XX in most cases or 46,XY in approximately 10-15% of cases. Additionally, complete moles show overexpression of several growth factors, including c-myc, epidermal growth factor, and c-erb B-2, compared with normal placenta.^[39]

Partial mole

In the incomplete or partial hydatidiform mole fetal tissue is often present, as well as amnion and fetal vessels with fetal red blood cells within the mesenchyme of the villi. Like in complete hydatidiform moles, hydropic (edematous) villi and trophoblastic proliferation are present. In addition, due to tangential sectioning, scalloping of the villi results in apparent trophoblastic inclusions within the mesenchyme of the villi. Paternally imprinted gene products (eg, p57, PHLDA2) are normally expressed only by maternal chromosomes. In the absence of maternal chromosomes, as is the case in complete moles, the nuclei of the villous stroma and the cytotrophoblasts do not stain for p57 or PHLDA2 (Pleckstrin homology-like domain, family A, member 2). In contrast, these cells are positive for p57 and PHLDA2 in partial moles (which are triploid) and missed abortion with hydropic degeneration (which are diploid).^{[40, 41, 42]}

Treatment & Management

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Media Gallery

Theca lutein cysts.
Complete mole.
Complete mole with an area of clot near cervix consistent with bleeding.
Twin gestation. Complete mole and normal twin.

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Author

Lisa E Moore, MD, MS, FACOG, RDMS Professor, Department of Obstetrics and Gynecology, Chief, Division of Maternal-Fetal Medicine, Medical Director of Labor and Delivery, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Lisa E Moore, MD, MS, FACOG, RDMS is a member of the following medical societies: American Congress of Obstetricians and Gynecologists, Central Association of Obstetricians and Gynecologists, International Society of Ultrasound in Obstetrics and Gynecology, Society for Maternal-Fetal Medicine, Society of Diagnostic Medical Sonography

Disclosure: Nothing to disclose.

Coauthor(s)

Enrique Hernandez, MD, FACOG, FACS Chairman, Department of Obstetrics and Gynecology, J Robert Willson Professor of Obstetrics, Gynecology and Reproductive Science, Professor of Pathology, Temple University Hospital, Lewis Katz School of Medicine at Temple University

Enrique Hernandez, MD, FACOG, FACS is a member of the following medical societies: Alpha Omega Alpha, American Cancer Society, American College of Obstetricians and Gynecologists, American College of Surgeons, American Gynecological and Obstetrical Society, American Medical Association, American Society for Colposcopy and Cervical Pathology, Association of Professors of Gynecology and Obstetrics, Johns Hopkins Medical and Surgical Association, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of Gynecologic Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

A David Barnes, MD, MPH, PhD, FACOG Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital (Mammoth Lakes, CA), Pioneer Valley Hospital (Salt Lake City, UT), Warren General Hospital (Warren, PA), and Mountain West Hospital (Tooele, UT)

A David Barnes, MD, MPH, PhD, FACOG is a member of the following medical societies: American College of Forensic Examiners Institute, American College of Obstetricians and Gynecologists, Association of Military Surgeons of the US, American Medical Association, Utah Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Leslie M Randall, MD, MAS, FACS Professor and Director, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Diane Harris Wright Professor of Gynecologic Oncology Research, Massey Cancer Center, Virginia Commonwealth University School of Medicine

Leslie M Randall, MD, MAS, FACS is a member of the following medical societies: Academy for Innovation in Medical Education, American College of Surgeons, American Medical Association, American Society of Clinical Oncology, International Gynecologic Cancer Society, Society of Gynecologic Oncology

Disclosure: Nothing to disclose.

Additional Contributors

Jordan G Pritzker, MD, MBA, FACOG Adjunct Professor of Obstetrics/Gynecology, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Attending Physician, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center; Medical Director, Aetna, Inc; Private Practice in Gynecology

Disclosure: Nothing to disclose.

Hydatidiform Mole Workup

Laboratory Studies

Imaging Studies

Histologic Findings

Complete mole

Partial mole

References

Tables

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