Intraoperative Molar Pregnancy Crisis

Abstract

ABSTRRACTMolar pregnancy is a gestation in which the ovum is transformed into a fleshy tumor mass or mole. Of all gynecologic tumors, it is one of the most feared. It is characterized by first trimester bleeding, hyperemesis, and toxemia and can be diagnosed using pelvic ultrasound. Suction curettage is the treatment of choice for molar pregnancy when a patient desires to have more children; however, hysterectomy may be necessary. Abdominal hysterectomy reduces the risk of malignant sequelae. Complications associated with molar pregnancy usually are a result of suction curettage and include pulmonary insufficiency syndrome, choriocarcinoma, hyperthyroidism, theca lutein cysts, and disseminated intravascular coagulation. The perioperative nurse can be instrumental in assessing, planning, organizing, and directing intervention for potential complications associated with the management of a molar pregnancy crisis. The perioperative nurse is encouraged to review all aspects of molar pregnancy to understand the ramifications of the surgical procedures. AORN J 60 (August 1994) 193–201.

Complete molar pregnancy with transformation to choriocarcinoma of the liver: A case report

“…Current literature on a complete molar pregnancy is reviewed with the case. A molar pregnancy is one in which an extra set of paternal chromosomes fertilize an egg with no genetic material or also called an empty egg [1] , [2] , [3] . Two variations of molar pregnancy are known; complete (diploid) and partial (triploid) [1] , [2] , [4] .…”

“…Complete molar pregnancies are thought to occur in 1:500–1:2000 pregnancies [1] , [2] , [3] , [4] . The majority of them, 90%, are from a single male sperm with a diploid genome (46XX) [3] , [7] . Once the empty egg is activated by the sperm, no zygote forms.…”

“…Once the empty egg is activated by the sperm, no zygote forms. Instead, colonic villi turn into grape like vesicles [3] , [6] . The exact cause is not known, but the incidence appears to have a bimodal age distribution for those in their teens and those between 40 and 50 years old [1] , [3] .…”

“…Instead, colonic villi turn into grape like vesicles [3] , [6] . The exact cause is not known, but the incidence appears to have a bimodal age distribution for those in their teens and those between 40 and 50 years old [1] , [3] . African American females have a higher chance of having a complete molar pregnancy and mortality from it [8] .…”

“…African American females have a higher chance of having a complete molar pregnancy and mortality from it [8] . Previous molar pregnancy increases incidence 20–40 × as does intermarriage [2] , [3] . A diagnosis of complete mole gives 15–28% chance of developing persistent disease and need for chemotherapy, but this decreases to 1.1% if HCG reaches 50 IU/L any time after evacuation of the pregnancy [4] , [9] .…”