4.Diagnosis and Differential diagnosis Diagnosis Clinical findings,expulsing of hydatid vesicles,B-hCG,ultrasound Persistent mole (persistent trophoblastic disease):3 months after total evacuation,HCG persistently positive Differential diagnosis Abortion:ultrasound Twin pregnancy:no bleeding Polyhydramnios:no bleeding
4. Diagnosis and Differential diagnosis Diagnosis ²Clinical findings, expulsing of hydatid vesicles, -hCG, ultrasound Persistent mole (persistent trophoblastic disease): 3 months after total evacuation, HCG persistently positive Differential diagnosis ²Abortion: ultrasound ²Twin pregnancy: no bleeding ²Polyhydramnios: no bleeding
5.Treatment A.Evacuation When diagnosis is confirmed Suction curettage:safe,rapid effective,with gentle sharp curettage Intravenous oxytocin should be given after a moderate amount of tissue has been removed to prevent hemorrhage and perforation Tissue from the decidua basalis for pathologic study Preparing for blood transfusion,laparotomy Rarely,molar tissue could not be removed at one time,after 1 week,again
5. Treatment A. Evacuation ²When diagnosis is confirmed ²Suction curettage: safe, rapid effective, with gentle sharp curettage ²Intravenous oxytocin should be given after a moderate amount of tissue has been removed to prevent hemorrhage and perforation ²Tissue from the decidua basalis for pathologic study ²Preparing for blood transfusion, laparotomy ²Rarely, molar tissue could not be removed at one time, after 1 week, again
B.Surgery Age>40 years,high risk,no desire of pregnancy -hysterectomy Theca lutein cysts:ovaries should remain intact,regression spontaneously,or aspirate under ultrasound,if torsion for long time, necrosis,cut
B. Surgery ²Age>40 years, high risk, no desire of pregnancy -hysterectomy ²Theca lutein cysts: ovaries should remain intact, regression spontaneously, or aspirate under ultrasound, if torsion for long time, necrosis, cut
C.Prophylactic chemotherapy Patient with large uterus or poor follow-up Suspected metastasis Abnormal higher hCG,or plateau Atypical hyperplasia Dactinomycin,5-Fu,MTX,single drug one course Surveillance toxicity
C. Prophylactic chemotherapy ²Patient with large uterus or poor follow-up ²Suspected metastasis ²Abnormal higher hCG, or plateau ²Atypical hyperplasia ²Dactinomycin, 5-Fu, MTX, single drug one course ²Surveillance toxicity
Projects 5-Fu 28mg/kg/d,d1-d8,iv drip Dactinomycin 500ug/d,d1-d5,iv drip Methotrexate (MTX)1.0mg-1.5mg/kg,IM ， d1,d3,d5,d7 tetrahydrofolic acid 0.1mg-0.15mg/kg,IM, d2,d4,d6,d8 Interval is 2 weeks
Projects 5-Fu 28mg/kg/d，d1-d8, iv drip Dactinomycin 500ug/d，d1-d5， iv drip Methotrexate (MTX) 1.0mg-1.5mg/kg，IM ，d1,d3,d5,d7 tetrahydrofolic acid 0.1mg-0.15mg/kg，IM， d2,d4,d6,d8 Interval is 2 weeks