What are the early symptoms of hydatidiform mole?

As a grape lover, besides knowing all kinds of things about grapes, you probably never thought that there is something called hydatidiform mole. Today, I will introduce to you what hydatidiform mole is and what are the early symptoms. Hydatidiform mole refers to the proliferation of trophoblastic cells of the placenta villi after pregnancy, severe edema of the interstitium, and the formation of blisters of varying sizes. The blisters are connected in clusters and shaped like grapes, also known as hydatidiform mole (HM). Hydatidiform mole is divided into two categories: ① Complete hydatidiform mole: all the placental villi are affected, the entire uterine cavity is filled with blisters, diffuse trophoblastic hyperplasia occurs, and no fetal and embryonic tissues are visible; ② Partial hydatidiform mole: some placental villi are swollen and degenerated, local trophoblastic hyperplasia occurs, and embryonic and fetal tissues are visible, but the fetus is mostly dead. Sometimes live fetuses younger than the gestational age or malformed fetuses can be seen, and full-term babies are rarely born.

The causes of hydatidiform mole are generally as follows:

1. Nutritional factors

Hydatidiform mole is more common in rice-eating countries, so it is believed to be related to nutrition. Studies have found that the activity of folic acid in the serum of patients with gestational trophoblastic tumor (GTT) is very low. Folic acid deficiency during the period of embryonic angiogenesis will affect thymine synthesis, leading to embryonic death and lack of blood vessels in the placental villi; low consumption of carotene in the diet increases the risk of hydatidiform mole; the incidence of hydatidiform mole increases in areas deficient in vitamin A; the content of trace elements Zn and Se in hydatidiform mole tissue decreases.

2. Infectious factors

Many authors believe that hydatidiform mole is related to viral infection, but no real evidence has been found so far.

3. Endocrine disorders

It is believed that the occurrence of hydatidiform mole is related to the imperfect or declining ovarian function, so it is more common in women under 20 years old and over 40 years old. Animal experiments have shown that removing the ovaries in early pregnancy can cause vesicular changes in the placenta, so it is believed that estrogen deficiency may be the cause of hydatidiform mole.

4. Defective fertilized egg

It may be related to abnormal development of the egg itself.

5. Racial factors

Racial differences in the incidence of hydatidiform mole have been noted. It has been reported that the incidence of hydatidiform mole in black women in the United States is only half that of other women. In Singapore, the incidence of hydatidiform mole in Eurasians is twice as high as that in Chinese, Indians and Malaysians.

6. Overexpression of oncogenes and inactivation of tumor suppressor genes

Oncogenes and tumor suppressor genes are genes that control cell growth and differentiation. The activation and overexpression of oncogenes and the mutation and inactivation of tumor suppressor genes are related to the occurrence of tumors.

Three clinical manifestations

1. Vaginal bleeding after menopause

Most patients experience irregular vaginal bleeding 2 to 4 months after amenorrhea. The amount is small at first and can easily be misdiagnosed as threatened abortion. The bleeding will gradually increase and often occur repeatedly. Sometimes blister-like tissue will be discharged naturally, which may lead to shock or even death.

2. Abdominal pain

When the molar pregnancy grows rapidly and the uterus expands rapidly, it can cause lower abdominal distension and pain. When the molar pregnancy is about to be expelled, there will be paroxysmal pain in the lower abdomen due to uterine contractions.

(1) Abnormal enlargement and softening of the uterus. Due to villous edema and intrauterine blood accumulation, the uterus of most patients with hydatidiform mole is larger than that of a normal pregnancy in the corresponding month and is softer in texture. In 1/3 of patients, the size of the uterus matches the month of menopause. Only a few cases are younger than the menopausal month, which may be due to the degeneration and cessation of development of the blisters.

(2) Symptoms of vomiting during pregnancy and gestational hypertension Since the proliferating trophoblastic cells produce a large amount of HCG, vomiting is often more severe than in normal pregnancy. Because the uterus of patients with hydatidiform mole grows rapidly and the tension in the uterus is high, pregnancy-induced hypertension syndrome may occur in the middle and early stages of pregnancy, and even acute heart failure or eclampsia may occur.

(3) Ovarian lutein cysts: Due to the stimulation of large amounts of HCG, patients with hydatidiform mole often develop multiple cysts on one or both ovaries. Generally no symptoms occur, but acute torsion occasionally causes acute abdominal pain. Lutein cysts may regress on their own after the hydatidiform mole is removed. Flavin cysts can store a large amount of HCG. Therefore, after the expulsion of hydatidiform mole and the patient with a giant flavin cyst, the disappearance of HCG in the blood and urine is slower than that of ordinary patients.

(4) Hyperthyroidism: A small number of patients with hydatidiform mole develop mild hyperthyroidism and elevated plasma thyroxine concentrations, but only about 2% develop obvious signs of hyperthyroidism. Symptoms disappear quickly after the hydatidiform mole is cleared.