Clinical features

Presentation is usually with:

• heavy or irregular vaginal bleeding, usually after 6-12 weeks of amenorrhoea. It is usually painless but may be associated with uterine contractions
• hyperemesis gravidarum - excessive nausea and vomiting
• pre-eclampsia - irritability, dizziness, photophobia

Examination usually reveals:

• enlarged uterus - in half of cases, this is greater than expected on the basis of the woman's LMP. This may cause confusion with a multiple pregnancy but usually, is remarkable for the absence of heart sounds. The uterus tends to have a doughy rather than cystic quality
• ovarian enlargement due to theca lutein cysts - occurs in one third of cases due to excess hCG
• signs of hypertension

Note that an invasive hydatidiform mole may metastasize e.g. to brain, lung, vagina, liver and skin.