Presentation and staging

♦ Bleeding in early pregnancy

♦ Toxaemia, hyperemesis, hyperthyroidism

About 15-20% of complete moles and 0.5% of partial moles will require chemotherapy. Staging of the disease involves ultrasound of the pelvis, serum HCG, and chest X-ray. In most instances the CXR will be normal but metastatic disease can present with:

♦ Cannonball secondaries

♦ Pleural effusions

♦ Wedge infarcts

♦ Oligaemic areas

♦ Cavitating lesions

♦ Miliary appearance

If there are chest lesions then a CT or preferably MRI brain scan is indicated prior to lumbar puncture for HCG analysis of the CSF (an HCG ratio of >1:60 (CSF: blood) indicates CNS involvement).

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