Hydatidiform mole

　　The true etiology of hydatidiform mole is unknown. Case-control studies have found that the occurrence of hydatidiform mole is related to nutritional status, socioeconomic status, and age. Age is a significant risk factor in etiology, with the incidence of hydatidiform mole in women over 40 being 10 times higher than in younger women. Women under a certain age are also at high risk for complete hydatidiform mole. Women in these two age groups are prone to fertilization defects, while partial hydatidiform mole is not related to the age of the pregnant woman.

　　The combination of cytogenetic and pathological studies has proven that the two types of hydatidiform mole have their own genetic characteristics. The karyotype of complete hydatidiform mole is of paternal origin, that is, it develops from the fertilization of an egg with a sperm nucleus after the egg pronucleus is missing or inactivated. The karyotype is diploid, with 90% being 46,XX, resulting from the fertilization of an empty egg (an egg without genetic material) with a haploid sperm (23,X) and subsequent self-replication to restore to diploid (46,XX), followed by growth and development. This is known as empty egg fertilization. A few karyotypes are 46,XY, which is the fertilization of an empty egg by two sperms with different sex chromosomes (23,X and 23,Y), known as double sperm fertilization. The karyotype of partial hydatidiform mole is often trisomic, with 80% being 69,XXY, and the rest being 69,XXX or 69,XYY, derived from a normal egg and double sperm fertilization, bringing an extra set of paternal chromosomes. It can also be caused by a normal haploid egg (or sperm) combined with a diploid gamete that failed in meiosis.

　　The complications of hydatidiform mole in the late stage include the following points:

　　1. Massive hemorrhage:If hydatidiform mole is not diagnosed and treated in time, it can cause repeated hemorrhage, uterine cavity hemorrhage, leading to hemorrhagic shock, even death. Therefore, hydatidiform mole should be treated as an emergency, and any short delay may cause more bleeding and harm the patient.

　　2. Incomplete abortion of hydatidiform mole:After spontaneous abortion or aspiration abortion, there may be residual vesicular masses. For patients with hydatidiform mole who have a spontaneous abortion not long before admission and can withstand the operation, immediate curettage should be performed. For those with a longer expulsion time and signs of infection, the curettage should be performed after the administration of antibiotics for several days.

　　3. Hydatidiform mole embolism:The vesicular mass can be transferred or migrate through the blood vessels to other parts of the body, most commonly to the lungs and vagina, and can form hemorrhagic foci locally. Small clots or those not strictly examined may resolve spontaneously. Pei Liang and others reported a case where hydatidiform mole widespread lung metastasis occurred due to the use of oxytocin induction, leading to pulmonary small artery spasm syndrome, and died of pulmonary edema and heart failure. Hydatidiform mole embolism may be different from the metastasis of malignant tumors and can be resolved by the body's own immune suppression. Currently, chemotherapy is still recommended after the discovery.

　　4. Malignant transformation:It may become invasive hydatidiform mole or choriocarcinoma. The malignant transformation rate is about 10% to 20%.

　　5. Torsion of the pedicle of the ovarian luteinizing cyst:It usually occurs after the expulsion of hydatidiform mole. When torsion of the pedicle of the ovarian luteinizing cyst occurs, the twisted uterine appendage should be immediately surgically removed.

　　1. Amenorrhea

　　Since hydatidiform mole occurs in the trophoblast of the embryo, most patients have 2 to 3 months or even longer amenorrhea.

　　2. Vaginal bleeding

　　It is a severe symptom, indicating spontaneous abortion of hydatidiform mole. It usually starts 2 to 3 months after amenorrhea, mostly intermittent and small amount of bleeding, but there may be repeated large hemorrhages. If examined carefully, vesicular-like objects may be found in the blood. Vaginal bleeding is obviously from the uterus, and part of it is accumulated in the uterus; it may also be completely accumulated in the uterus temporarily, thus prolonging the amenorrhea period.

　　3. Uterine enlargement

　　The uterus of most patients is larger than the corresponding gestational uterus of the menstrual period. Many patients come to seek medical attention due to palpable lower abdominal mass (enlarged uterus or luteal cyst), but there are also a few cases where the uterus size and menstrual period are very similar or even smaller than the menstrual period. There may be two situations:

　　1. The villous vesicles degenerate and become atrophic, ceasing development and forming a hydatidiform mole.

　　2. Some vesicular masses have been discharged, causing the uterine body to shrink and forming an incomplete abortion of hydatidiform mole.

　　4. Abdominal pain

　　Due to the rapid enlargement of the uterus, there may be pain, or bleeding within the uterus can stimulate uterine contraction and cause pain, which can be mild or severe.

　　5. Symptoms of pregnancy-induced hypertension

　　About half of the patients may experience severe vomiting after menopause, and later may experience hypertension, edema, and proteinuria.

　　6. No fetus can be felt

　　Around 8 weeks before and after amenorrhea, B-ultrasound monitoring does not show a gestational sac, fetal heart rate, or fetus, gestational age, and even by 18 weeks, there is no feeling of fetal movement, and the fetal heart rate cannot be heard. B-ultrasound scanning shows snowflake-like images without fetal images.

　　7. Ovarian luteinizing cyst

　　Ovarian luteinizing cysts often occur in some patients, which can be detected by bimanual examination or more easily by ultrasound.

　　8. Hemoptysis

　　Some patients may have hemoptysis or sputum with blood, and doctors should actively inquire about whether they have this symptom.

　　9. Anemia and infection

　　Recurrent bleeding that is not treated in a timely manner will inevitably lead to anemia and related symptoms, and some individuals may even die due to bleeding. Recurrent bleeding is prone to infection, such as unclean vaginal manipulation or sexual intercourse during the bleeding period, which is more likely to promote the occurrence of infection. Infection can be localized in the uterus and its appendages, and can lead to sepsis.

　　Two factors are more likely to cause hydatidiform mole: the mother's age and pregnancy history. In terms of age, mothers under 20 years old and those over 40 years old who are pregnant are 5-9 times more likely to have hydatidiform mole than those between 21 and 35 years old. Mothers over 40 years old are at a higher risk than those under 20 years old. The father's age does not have an impact. In terms of pregnancy history, mothers with two or more consecutive spontaneous abortions are 32 times more likely to have hydatidiform mole than normal mothers, which means that mothers with consecutive spontaneous abortions are more prone to hydatidiform mole. When compared to other countries, Asian countries have a higher incidence rate. On average, worldwide, there are about 0.5-2 hydatidiform moles among every 1000 pregnant women. Therefore, the prevention of hydatidiform mole is very important.

　　General measures for the prevention of hydatidiform mole are as follows:

　　5. Maintain a good mood and emotional state, and enhance the ability to resist diseases.

　　4. Avoid heavy physical labor and engage in moderate exercise. After discharge, patients can perform some limb exercises according to their physical condition, such as walking, jogging, practicing Tai Chi, etc., and do household chores within their capabilities, ensuring not to feel tired, and ensuring adequate sleep.

　　3. Abstain from sexual intercourse and bathing in a bathtub within one month. After hydatidiform mole, normal sexual life is encouraged, and it is required to take serious precautions for contraception, follow-up for at least 2 years, and strictly use contraception for 1-2 years, preferably using condoms, and it is not advisable to use intrauterine devices or oral contraceptives.

　　To avoid difficulties in distinguishing between a second pregnancy and malignancy. Contraception methods should be chosen such as condoms and vaginal diaphragms.

　　4. Regular follow-up is recommended. All patients with hydatidiform mole should be advised to have regular follow-up, preferably maintaining long-term contact with the hospital. More importantly, regular复查 within 2 months is aimed at early detection of malignancy, but sometimes there may also be residual vesicular masses. The pregnancy test is very important during the follow-up. After the complete clearance of hydatidiform mole, more than 60% of patients will have a negative pregnancy test within 30 days. If the test remains positive after more than 40 days, there should be a high suspicion of malignancy or residual vesicular masses.

　　5. During the follow-up examination, in addition to asking about the normality of the menstrual cycle, attention should also be paid to whether the above symptoms are present. During the examination, attention should be paid to whether the uterus has recovered well, whether there are purple and blue nodules on the vulva, and whether there are shadows on the chest X-ray.

　　1, An abdominal ultrasound scan can show varying sizes of dark areas within the uterus, which are caused by uterine hemorrhage. It can also detect the fetus, which may include fetal and/or placental images in addition to snowflake-like spots. Ultrasound diagnosis is non-invasive and has a high diagnostic rate, and is indeed a powerful measure for confirming hydatidiform mole. hCG measurement: Accurate quantitative testing of hCG is an important test for diagnosing and following up on hydatidiform mole. hCG levels are low at the beginning of a normal pregnancy and reach their peak at 8 to 10 weeks of gestation, after which they gradually decline. After 100 days of gestation, hCG levels drop significantly. In twin (multiple) pregnancies, hCG levels are also higher than in single pregnancies. In hydatidiform mole, hCG levels are much higher than normal and remain at a high level. In normal non-pregnant women, serum hCG levels are less than 75 mIU/ml, and β-hCG is less than 20 mIU/ml. The median peak value in the serum of normal pregnant women is below 100,000 mIU/ml, and the highest value reaches 210,000 mIU/ml. In hydatidiform mole patients, serum hCG levels are much higher than 200,000 mIU/ml. Therefore, combined with clinical findings and ultrasound, a single high hCG value can confirm the diagnosis of hydatidiform mole. If a stage-specific follow-up quantitative hCG test is performed and the hCG level remains high after 14 weeks of gestation, the diagnosis can be more definitive.

　　2, If the grape mole is eliminated for more than 8 weeks, and it is confirmed through careful curettage that there is no residual grape mole in the uterine cavity, no cholesterinoma is present, and the serum hCG level remains above 1000 mIU/ml or continues to rise, and there is further evidence of malignant transformation, hCG values below 1000 mIU/ml but with the presence of cholesterinoma, careful examination is still needed to determine if there are any metastatic lesions present, or it may be due to cholesterinoma of the ovary. It is still necessary to follow up closely, and if the cholesterinoma regresses along with the decrease in hCG levels, follow-up should continue as for a benign grape mole.

　　Patients with hydatidiform mole should pay attention to their daily diet and improve their body's resistance while undergoing active treatment. The following are five dietary注意事项 for patients with hydatidiform mole:

　　① Fresh and hygienic foods should be chosen.

　　② The variety of dishes should be rich, and a balanced diet should be followed to avoid eating the same dish repeatedly.

　　③ The ratio of staple food to side dish should be 1:1. In staple foods, it is recommended to alternate between rice, flour, and coarse grains, and include coarse grains. In side dishes, the ratio of vegetables and fruits to protein-rich foods should be 5:1.

　　④ In protein-rich foods, the ratio of animal protein to plant protein should be about half, and sweet foods and processed foods should be used less.

　　⑤ It is not advisable for the daily fat intake to exceed 509 grams. Eat less meat and more fish and its products, and try to choose foods that are beneficial for anti-cancer and cancer prevention.

　　Early-stage patients with hydatidiform mole have no difference from healthy people and do not need to avoid certain foods. Late-stage patients often lack appetite or have difficulty eating, the food they eat should have sufficient calories and protein, rich in vitamins, and low in fat and sugar, and should be easy to digest and absorb. Respect the patient's dietary habits and never force the patient to eat things they are not accustomed to. Patients with hydatidiform mole should use some food therapy prescriptions cautiously under the doctor's instructions according to their specific condition. The following are introduced:

　　1. Chinese Yam and American Ginseng Stewed Sea Cucumber

　　Herbs and usage: Dried sea cucumber 96g, American ginseng 10g (separately packaged, only cooked for 15 minutes), pork spine 250g, Chinese yam 65g, salt and peanut oil as needed. First, cut the dried sea cucumber into small pieces and place them with the chopped pork spine in a large炖盅, add Chinese yam and an appropriate amount of water, bring to a boil and then simmer over low heat for 1 hour, then add slices of American ginseng, lycium barbarum, cooking oil, and salt, and simmer for another 15 minutes. Drink the soup in portions and eat the sea cucumber.

　　Effect: Prevent cancer and anticancer, tonify Qi and benefit blood.

　　2. Stir-fried Eggplant and Enoki Mushrooms with Geese Blood

　　Herbs and usage: Eggplant 125g (cleaned, with skin, cut into pieces), Enoki mushrooms 150g (cleaned, cut into sections), geese blood 96g. First, stir-fry the eggplant and enoki mushrooms with peanut oil and appropriate salt over low heat until they are seven or eight degrees cooked, then add the geese blood and stir-fry quickly, serve with dishes. Take 1-2 doses per day, can be used continuously for 7-10 days, or can be alternated with other anticancer and anticarcinogenic food therapy formulas.

　　Effect: Tonify blood, prevent cancer and anticancer.

　　3. Lycium barbarum and Coix Seed Porridge

　　Herbs and usage: Lycium barbarum 20g, Coix seed 20g, and rice 60g. Cook into porridge for consumption, with the functions of tonifying the kidneys, strengthening the spleen, and clearing heat.

　　4. Coix Seed and Snake Grass Drink

　　Herbs and usage: Coix seed, Semilobum chinense, and Hedysarum sibiricum each 30g. Boil the water and drink as tea, one dose per day, with anticancer and anticarcinogenic effects. Traditional Chinese medicine: Dahuang Zhechong pills: with the effect of removing blood stasis and promoting new blood, it is used to treat fatigue, emaciation, abdominal distension and pain, dry blood in the interior, etc.

　　The etiology of hydatidiform mole is mainly due to insufficient true Qi of the internal organs, weakened Yang Qi, leading to an unhealthy embryo, failure of the fetus to take shape, and the coagulation of essence and blood in the uterus, which cannot be transformed, resulting in rapid enlargement of the abdomen. Due to the coagulation of blood stasis in the uterus, the collaterals and meridians are blocked, and it is difficult for new blood to settle, hence the appearance of vaginal bleeding after several months of amenorrhea, with a large amount of blood and a substance resembling a toad's egg excreted with it. In addition, there are also cases where the internal organs are out of balance, the vital Qi is weak, and during pregnancy, the pathogenic factors of dampness-heat and turbidity take the opportunity to invade the uterus, accumulate in the collaterals and meridians, obstruct the flow of Qi and blood, leading to the intermingling of blood stasis and heat, damaging the fetus, and forming a 'ghost fetus'. Currently, the treatment of this disease solely relying on traditional Chinese medicine and herbs is less effective, and it is difficult to quickly eliminate the pathogen. Modern medical treatment methods should be the main approach, through clearing the uterine cavity and quickly removing the focus of disease to effectively control the disease. On this basis, combined with traditional Chinese medicine and herbs for辨证treatment, it can both reinforce the healthy Qi and eliminate pathogenic factors, often leading to satisfactory therapeutic effects. The treatment of this disease should be based on the basic principle of adjusting the Yin and Yang balance of the internal organs, considering both reinforcing the healthy Qi and eliminating pathogenic factors. For those with Yang deficiency and blood stasis, the focus is on warming the kidneys and transforming Yang, promoting blood circulation and removing blood stasis; for those with damp-heat and blood stasis obstruction, it is necessary to clear heat and eliminate dampness, detoxify and remove blood stasis, and pay attention to regulating Qi and blood. The specific therapy should mainly be oral decoctions or pills.

　　(1) Differential diagnosis and prescription selection

　　1. Yang deficiency and blood stasis

　　Treatment method: Warm the kidneys and support Yang, promote blood circulation and remove blood stasis

　　Prescription: Shaofu Xue Yu decoction with addition and subtraction.

　　Composition: Dang Gui 15g, Chi Shao 15g, Chuan Xiong 10g, Xiao Hui Xiang 10g, Rou Gui 10g, Pu Huang 15g, Niuxi 15g, Yi Mu Cao 30g, Bai Hua She Tong Cao 30g, Hong Hua 15g. For those with severe blood stasis, add 15g of San Lie, 15g of Ai Zhu.

　　Addition and subtraction: For those with severe nausea and vomiting, add 15g of Jiang Zhu Ru, 15g of Jiang Ban Xia; for those with deficiency of both Qi and blood, add 20g of Dang Shen, 25g of Huang Qi, 15g of Bai Zhu; for those with abdominal pain, add 20g of Bai Shaoyao.

　　2. Blood stasis and heat intermingling

　　Treatment method: Clear heat and remove dampness, detoxify and remove blood stasis

　　Prescription: Pu Gong Ying Bai Jiang decoction with addition and subtraction.

　　Composition: Pu Gong Ying 30g, Bai Jiang Cao 20g, Huang Bai 15g, Bai Hua She Tong Cao 30g, Hong Hua 15g, Hong Teng 30g, Dan Pi 15g, Dan Shen 15g, Fu Ling 15g

　　Addition and subtraction: For those with low fever and chest stuffiness, add 15g of Huang Qin, 10g of Chai Hu; for those with severe nausea and vomiting, add 15g of Jiang Zhu Ru, 15g of Jiang Ban Xia; for those with loose stools and general weakness, add 15g of Dang Shen, 20g of Bai Zhu, 20g of Yu Zao.

　　(2) Traditional Chinese Medicine Treatment

　　1. Da Huang Zhe Chong Wan: Has the effect of removing blood stasis and promoting the formation of new blood, mainly for five kinds of fatigue, emaciation, abdominal distension and pain, dry blood in the interior, etc. It can be used to treat hydatidiform mole. Take one pill, three times a day, orally.

　　2. Guizhi茯苓丸: Has the effect of promoting blood circulation and removing blood stasis, slowly dissolving masses, mainly for women with long-standing masses in the lower abdomen, abdominal distension and pain during amenorrhea. It can be used to treat hydatidiform mole. Take one pill, three times a day, orally.

　　(3) Acupuncture

　　Acupuncture point treatment: Perpendicular insertion of Qu Chi point 1-1.2 cun, direct insertion of San Yin Jiao point from inside to outside 0.5-1.0 cun, once a day.