Benign hydatidiform mole

　　The etiology of hydatidiform mole is unclear. Studies have found that the occurrence of hydatidiform mole is related to nutritional status, socio-economic status, and age. Age is a significant risk factor in etiology, and the incidence of hydatidiform mole in women over 40 is 10 times higher than that in young women.

　　1, Massive hemorrhage

　　If hydatidiform mole is not diagnosed and treated in time, it can lead to recurrent bleeding, uterine cavity hematoma, causing hemorrhage. It can also lead to massive bleeding during spontaneous expulsion. On the basis of anemia, hemorrhagic shock, even death, can occur. Therefore, hydatidiform mole should be treated as an emergency. Short-term delay can cause more bleeding and harm the patient.

　　2, Incomplete abortion of hydatidiform mole

　　After spontaneous abortion or suction curettage, there may be residual vesicular fetal masses. For patients with hydatidiform mole who have a spontaneous abortion not long before admission and can withstand curettage, immediate curettage should be performed. For those with a longer expulsion time and signs of infection, antibiotic control should be used for a few days before curettage.

　　3, Hydatidiform mole embolism

　　Vesicular fetal masses can be transferred through blood circulation or migrate to other parts of the body, most commonly to the lungs and vagina, and can form hemorrhagic foci locally. Small clots or those not thoroughly examined may resolve spontaneously. Pei Liang et al. reported that one case of hydatidiform mole widespread lung metastasis caused by the use of oxytocin for induction of labor, leading to pulmonary small artery spasm syndrome, and died of pulmonary edema and heart failure. Hydatidiform mole embolism can be different from the metastasis of malignant tumors and can be resolved by the body's own immune suppression, as reported by Lin Qiaozi and Su Yingkuan. Currently, chemotherapy is still recommended after the diagnosis is made.

　　4, Malignant transformation

　　The risk of becoming invasive hydatidiform mole or choriocarcinoma is about 10% to 20%. Detailed information will be provided later. Ovarian luteinizing cyst torsion often occurs after the expulsion of hydatidiform mole. When torsion occurs, the twisted uterine appendages should be surgically removed immediately.

　　The pregnancy reaction in hydatidiform mole is earlier and more obvious than that in normal pregnancy. Vaginal bleeding often starts 6 to 8 weeks after amenorrhea, initially with less bleeding and dark red blood. It gradually increases or continues to bleed, with an incidence rate of more than 96%. Usually, massive bleeding can occur around the 4th month of pregnancy when the fetus is about to be spontaneously expelled, and grape-like tissue can be seen. At this time, there is often a large amount of bleeding. If not treated in time, it can lead to shock, even death. Abdominal pain is not common, and if it occurs, it is usually hidden abdominal pain. However, during the expulsion of hydatidiform mole, there may be intermittent abdominal pain, often with a large amount of bleeding. Some patients may also have hypertension, edema, proteinuria, and even eclampsia or heart failure, which are rarely seen in normal pregnancy. Chronic vaginal bleeding can lead to varying degrees of anemia and infection.

　　All patients with hydatidiform mole should be advised to follow up regularly, and it is best to maintain long-term contact with the hospital. More importantly, regular follow-up within 2 years is necessary, the purpose of which is to detect malignant transformation early. However, there may also be residual vesicular fetal masses. Patients should be advised to take effective contraception measures at least within 2 years. In the first half year, they should have a follow-up examination once a month. If irregular vaginal bleeding, hemoptysis, headache, or other discomfort occurs, they should go to the hospital for an immediate check.

　　During the follow-up examination, in addition to asking about the normality of menstruation, attention should also be paid to the presence of the above symptoms. During the examination, attention should be paid to whether the uterus has recovered well, and whether there are purple-blue nodules in the vagina and vulva. Chest X-ray (it is best to take a chest film) may show shadows.

　　Pregnancy tests are very important during follow-up. After the hydatidiform mole is completely cleared, more than 60% of patients will have a negative pregnancy test within 30 days. If the test is still positive after more than 40 days, it should be highly suspected of malignancy or residual vesicular mass. If the pregnancy test has turned negative and then turned positive during follow-up, if not pregnant, it should be highly suspected of malignancy. If the original urine is positive and the dilution test has turned negative, and the dilution test turns positive again during follow-up, especially if the dilution degree is increased, it should also be highly suspected of malignancy.

　　1. hCG Determination

　　The trophoblastic cells of hydatidiform mole overproliferate, producing a large amount of hCG, which is higher than that of normal pregnancy of the corresponding month.

　　2. B-ultrasound Examination

　　During the B-ultrasound examination, there is no fetal, placental, or amniotic fluid image in the uterine cavity, only 'snowflake' echoes can be seen. If there is bleeding, irregular liquid dark areas can be seen. 'Snowflake' echoes are a specific imaging feature of hydatidiform mole.

　　3. Fetal Heart Sound Measurement

　　In normal pregnancy with atypical symptoms and normal fetal heart sound, Doppler can hear the fetal heart sound after 2 months, but only uterine blood flow sounds can be heard in hydatidiform mole.

　　4. X-ray Examination

　　Although the uterus has exceeded 5 months of pregnancy size, the fetal skeleton cannot be seen in abdominal X-ray films.

　　In addition to conventional treatment, attention should be paid to a reasonable diet, ensuring comprehensive and balanced nutrition, and eating light and non-spicy foods. Specific dietary advice should be consulted with a doctor based on symptoms.

　　1. Evacuation of the Uterus

　　Once a hydatidiform mole is diagnosed, it should be immediately evacuated, usually by electric aspiration and curettage. Another curettage can be performed a week later. Blood transfusion preparation should be made before the operation, and precautions should be taken to prevent uterine perforation during the operation. Antibiotics should be used before and after the operation to prevent infection.

　　2. Prevention of Malignancy

　　Preventive hysterectomy is not commonly used at present, but it can also be considered for older individuals without fertility requirements.

　　3. Follow-up

　　After the hydatidiform mole is expelled, check hCG once a week for the first week, and then once every 1-2 months after it becomes negative. In the second year, check once every 6 months at least for two years. While checking hCG, regular chest X-rays should be taken to avoid the occurrence of hydatidiform mole or malignancy twice. Instruct patients to continue contraception for 1-2 years to avoid recurrence.