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Hydatidiform mole (HM) represents the benign spectrum of gestational trophoblastic disease (GTD), an abnormal pregnancy characterized by aberrant fertilization of the oocyte.1 The treatment of HM is uterine evacuation, usually done through electric vacuum aspiration (EVA). However, numerous conditions—including legal, religious, and economic—prevent several countries from having access to the devices used to perform EVA. In Brazil the vast majority of GTD Reference Centers do not have EVA, so more than 70% of HMs are treated with manual vacuum aspiration (MVA).2 The aim of this video article is to present a representative case where MVA is used for evacuation of HM (Video 1).
After approval by the Rio de Janeiro Federal University Institutional Review Board in February 2021 (number: 4.555.188) and obtaining written informed consent from the patient, we describe a case of a patient at 12 weeks gestation who was referred to our institution due to bleeding, uterus larger than gestational age, human chorionic gonadotropin of 178 678 IU/L, and ultrasonography suggesting HM. She underwent uterine MVA for the treatment of a molar pregnancy.
In the video we show the MVA technique for the treatment of HM, as well as strategies to make the surgery safer and more effective (see also online supplemental tables 1 and 2). There are two important tips for performing molar MVA: the first is to have two aspiration syringes, which makes the procedure more efficient, and the second is to perform cervical dilation with the plastic cannulas themselves, minimizing the risk of perforation.3 Ultrasonography guidance during the procedure assists in monitoring uterine evacuation, avoiding uterine perforation, and helping to ensure complete evacuation. When the contents of the syringe become pink and bullous, it is a sign that the uterine cavity is empty.4 A gentle uterine sharp curettage after molar evacuation is important to remove any adherent trophoblastic tissue remnants.
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Twitter @BragaDTG
Contributors AB: Surgeon, development of paper, review of the literature. LP: Surgeon, development of paper, review of the literature. JR-F: Ultrasonographer, development and review of paper. KE, NH, RB: Development and review of paper. All authors approved the final version.
Funding This research was supported by the National Council for Scientific and Technological Development – CNPq (AB), Donald P. Goldstein MD Trophoblastic Tumor Registry Endowment and the Dyett Family Trophoblastic Disease Research and Registry Endowment (KME, NSH, RSB).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.