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Final Thesis 12

Waktu Solat refers to the five daily Islamic prayer times observed by Muslims. Each prayer time is determined by the sunu2019s position from Subuh (dawn) to Isyak (night). In Malaysia, official Waktu Solat schedules such as Waktu Solat Kajang, Waktu Solat Penang, or Waktu Solat KL are updated daily by JAKIM to ensure accuracy. Checking Waktu Solat helps Muslims plan their day around worship and maintain spiritual discipline, whether at home, work, or while traveling.

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Final Thesis 12

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  1. Waktu Solat refers to the five daily Islamic prayer times observed by Muslims. Each prayer time is determined by the sun’s position — from Subuh (dawn) to Isyak (night). In Malaysia, official Waktu Solat schedules such as Waktu Solat Kajang, Waktu Solat Penang, or Waktu Solat KL are updated daily by JAKIM to ensure accuracy. Checking Waktu Solat helps Muslims plan their day around worship and maintain spiritual discipline, whether at home, work, or while traveling.A thesis Submitted by AYESHA TANVEER BSMIT-F21-084 MAHLAQA ALI BSMIT-F21-157 AROOJ SAEED BSMIT-F21-081 IQRA AYUB BSMIT-F21-144 TOOBA AKRAM BSMIT-F21-139 M. HASSAN BSMIT-F21-094 In Partial Fulfilment of the award Bachelor’s in Medical Imaging Technology Supervisor: Mr. Jahanzaib BSMIT, MSMIT Co-Supervisor: Mr. Ali Raza BSMIT, MSDU* Department of Radiological Sciences and Medical Imaging Technology Superior University Lahore. i

  2. Superior University Lahore Department of Radiological Sciences and Medical Imaging Technology UNDERTAKING BY STUDENTS We, Ayesha Tanveer, Mahlaqa Ali, Arooj Saeed, Iqra Ayub, Tooba Akram, Muhammad Hassan Regd. No. BSMIT-F21-084), (BSMIT-F21-157), (BSMIT-F21- 081), (BSMIT-F21-144), (BSMIT-F21-139), (BSMIT-F21-094) declare that the contents of our research project entitled “Role of Ultrasound in Evaluating Molar Pregnancies inFirstTrimester and its Correlation with Maternal Age.” Are based on our own research finding and have not been taken from any other work except the references and has not been published before. AYESHA TANVEER MAHLAQA ALI AROOJ SAEED IQRA AYUB TOOBA AKRAM MUHAMMAD HASSAN ii

  3. Superior University Lahore Department of Radiological Sciences and Medical Imaging Technology Faculty of Allied Health Sciences SUPERVISORY COMMITTEE We, the supervisory committee certify that the contents and the form of thesis submitted by Ayesha Tanveer (Bsmit-f21-084) Mahlaqa Ali (Bsmit-f21-157) Arooj Saeed (Bsmit-f21-081) Iqra Ayub (Bsmit-f21-144) Muhammad Hassan (Bsmit-f21-094) Tooba Akram (Bsmit-f21-139) have been found satisfactory and recommended for the award of degree of Bachelor’s in Medical Imaging Technology Supervisor: Mr. Jahanzaib BSMIT, MSMIT Co-Supervisor Mr. Ali Raza BSMIT, MSDU* HOD Ms. Fariha Ambreen MS Rehabilitation Sciences Ph.D. Rehabilitation Sciences* Convener Research Review Board Prof. Dr. Muhammad Naveed Ph.D. Rehabilitation Sciences iii

  4. Superior University Lahore Department of Radiological Sciences and Medical Imaging Technology Faculty of Allied Health Sciences SUPERVISOR LETTER I, Jahanzaib Ahmad certify that the contents and the form of research project submitted by Ayesha Tanveer, Mahlaqa Ali, Arooj Saeed, Iqra Ayub, Muhammad Hassan, Tooba Akram Regd. No. (BSMIT-F21-084), (BSMIT-F21-157), (BSMIT-F21-081), (BSMIT-F21-144), (BSMIT-F21-094), (BSMIT-F21-139)have been found satisfactory and recommend it for the evaluation of the External Examiner for the award of degree of Bachelors in Medical Imaging Technology. Date: _______________ ___________________ Mr. Jahanzaib BSMIT, MSMIT iv

  5. Superior University Lahore Department of Radiological Sciences and Medical Imaging Technology Faculty of Allied Health Sciences CO-SUPERVISOR LETTER I, Ali Raza certify that the contents and the form of research project submitted by Ayesha Tanveer, Mahlaqa Ali, Arooj Saeed, Iqra Ayub, Muhammad Hassan, Tooba Akram Redg. No. (BSMIT-F21-084), (BSMIT-F21-157), (BSMIT-F21-081), (BSMIT-F21- 144), (BSMIT-F21-094), (BSMIT-F21-139) have been found satisfactory and recommend it for the evaluation of the External Examiner for the award of degree of Bachelors in Medical Imaging Technology. Date: ______________________________ Ali Raza BSMIT, MSDU* v

  6. Superior University Lahore Department of Radiological Sciences and Medical Imaging Technology Faculty of Allied Health Sciences BIOSTATISTICIAN LETTER I, Adeel Saleem certify that the statistical analysis of research project submitted by Ayesha Tanveer, Mahlaqa Ali, Arooj Saeed, Iqra Ayub, Muhammad Hassan, Tooba Akram Regd. No. (BSMIT-F21-084), (BSMIT-F21-157), (BSMIT-F21-081), (BSMIT- F21-144), (BSMIT-F21-094), (BSMIT-F21-139)has been found satisfactory for the award of degree of Bachelors in Medical Imaging Technology. Date: __________________________________ Muhammad Adeel Saleem (BSRIT, MSDU, PhD*) vi

  7. Superior University Lahore Department of Radiological Sciences and Medical Imaging Technology Faculty of Allied Health Sciences EXAMINATION COMMITTEE The Research project and its presentation of Ayesha Tanveer (Bsmit-f21-084) Mahlaqa Ali (Bsmit-f21-157) Arooj Saeed (Bsmit-f21-081) Iqra Ayub (Bsmit-f21-144) Muhammad Hassan (Bsmit-f21-094) Tooba Akram (Bsmit-f21-139) at the Department of Allied Health Sciences, Superior University, Lahore. The Supervisory and Examination Committee gave satisfactory remarks on the Research project and Presentation and were approved for the award of the degree of Bachelors in Medical Imaging Technology. __________________ _________________ Member Mr.Ali Nouman Ms. Iqra Saeed BSMIT, MSMIT (BSRIT, MSBMS) __________________ _________________ Member – RRB Munazza Shahid Fariha Ambreen MID, MSDU MS Rehabilitation Sciences Ph.D. Rehabilitation Sciences ____________________________________ Convener – Research Review Board Prof. Dr. Muhammad Naveed Babur Ph.D. (Rehabilitation Sciences) Program Leader – RRB HOD vii

  8. Superior University Lahore Department of Allied Health Sciences Medical Imaging Technology PLAGIARISM EVALUATION REPORT This is to certify that I have examined the Turnitin report of the thesis entitled “Role of Ultrasound in Evaluating Molar Pregnancies inFirstTrimester and its Correlation with Maternal Age.” The thesis contains no text that can be regarded as plagiarism. The overall similarity index obtained from the Turnitin software is 9%. Date: __________________ ________________ Research Coordinator Mr. Loqman Shah (BSRT, MSMIT) viii

  9. Dedicated To, Our parents, whose unwavering support and encouragement have been our greatest source of strength. To our mentors and teachers, who guided us with wisdom and patience, and to all those who have inspired us throughout this academic journey. ix

  10. ACKNOWLEDGEMENT We would like to extend our heartfelt gratitude to our supervisor, Mr. Jahanzaib, and our co-supervisor Mr. Ali Raza for their invaluable guidance, support, and encouragement throughout this research. We also thank our professors, mentors, and research committee members for their constructive feedback and expertise. We also acknowledge the financial and institutional support provided by Superior University, Lahore. Finally, we express our deepest gratitude to our families and friends for their patience, understanding, and encouragement during this challenging yet rewarding journey. x

  11. LIST OF ABBREVIATIONS Abbreviations HM Full form Hydatidiform Mole PM Partial Mole CM Complete Mole TAS Transabdominal Scan MHz Megahertz TP Trophoblastic Proliferation PD Prenatal Diagnosis CP Cystic Placenta GTD Gestational Trophoblastic Disease xi

  12. TABLE OF CONTENTS Sr.no.Contents 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 4.6.1: Inclusion criteria 4.6.2: Exclusion criteria 19 20 21 22 23 24 25 26 27 Page No I-IX X XI 2 5 9 21 21 22 23 24 24 24 24 24 24 24 24 24 25 26 27 28 28 29 39 40 41 LETTERS ACKNOWLEDGEMENT LIST OF ABBREVIATIONS ABSTRACT CHAPTER 1: INTRODUCTION CHAPTER 2: REVIEW OF LITERATURE CHAPTER 3: 3.1: OBJECTIVES 3.2: PROBLEM STATEMENT 3.3: OPERATIONAL DEFINITIONS CHAPTER 4: MATERIAL & METHODS 4.1: Study design 4.2: Setting 4.3: Study duration 4.4: Sample size 4.5: Sampling technique 4.6: Sample Selection 4.7: Equipment(s) 4.8: Ethical Considerations 4.9: Data Collection Procedure 4.10: Data Analysis 4.11: Gantt Chart CHAPTER 5: RESULTS CHAPTER 6: DISCUSSION CHAPTER 7: 7.1: Conclusion xii

  13. 7.2: Recommendations 7.3: Limitations CHAPTER 8: REFERENCES CHAPTER 9: ANNEXURE 42 43 44 49 49 69 70 71 72 73 74 28 29 30 31 32 33 34 35 36 37 38 9.1: Images 9.2: Consent Forms 9.3: Urdu consent form 9.4: Supplementary Table 9.5: Single Patient Sheets 9.6: Ten Patients Data Sheet 9.7: Plagiarism Report xiii

  14. LIST OF TABLES S. NoTables Page No 29 1 Table 5.1 Frequency of Maternal Age Distribution 30 2 Table 5.2 Frequency of Lace Like Pattern 31 3 Table 5.3 Frequency of Cystic Lesion 32 4 Table 5.4 Frequency of Enlarged Uterus 33 5 Table 5.5 Frequency of Bunch of Moles 34 6 Table 5.6 Frequency of Snowstorm Pattern 35 7 Table 5.8 Frequency of Vaginal Bleeding 36 8 Table 5.9 Frequency of Lower Abdominal Pain 37 9 Table 5.10 Frequency of Types of Molar Pregnancy xiv

  15. LIST OF FIGURES Sr. Figures Page No Figure 5.1 Pie chart of Maternal Age Distribution 29 1 Figure 5.2 Pie chart of Lace Like Pattern 30 2 Figure 5.3 Pie chart of Cystic Lesion 31 3 Figure 5.4 Pie chart of Enlarged Uterus 32 4 Figure 5.5 Pie chart of Bunch of Moles 33 5 Figure 5.6 Pie chart of Snowstorm Pattern 34 6 Figure 5.8 Pie Chart of Vaginal Bleeding 35 7 Figure 5.9 Pie Chart of Lower Abdominal Pain 36 8 Figure 5.10 Pie Chart of Types of Molar Pregnancy 37 9 1

  16. ABSTRACT Background: A molar pregnancy and other types of gestational trophoblastic disease are growth of abnormal fertilized egg or an overgrowth of tissues from the placenta. Ultrasound is a primary diagnostic tool to detect molar pregnancies and other types of GTD in first trimester in relation to maternal age. Early detection is crucial to prevent complications like persistent GTD or progression to choriocarcinoma. Objective: Role of ultrasound in identifying molar pregnancies in first trimester and its correlation with maternal age. Methodology: This research was conducted descriptive cross-sectional study to evaluate the role of ultrasound in the diagnosis of molar pregnancies during the first trimester and to analyze its correlation with different maternal age groups that are categorized into three age groups: 20–28 years, 28–33years, and above 37 years. The study was carried out in the Radiology and Obstetrics & Gynecology Departments of Mayo Hospital Lahore, over a period of Oct 2024 till April 2025. A total of 32 pregnant women in their first trimester up to 13 weeks of gestation, who were clinically suspected of having abnormal pregnancies were included in the study. Exclusion criteria includes incomplete clinical records or inadequate ultrasound visualization and known history of other gestational trophoblastic diseases. Results: The study includes a sample size of 31 patients. Maternal age plays a significant role, with a higher prevalence in younger women (21–28 years), though a notable proportion of cases were also observed in those over 38, highlighting advanced maternal age as a risk factor. Common ultrasound features like cystic lesions (64.5%) and an enlarged uterus (67.7%) are highly prevalent in molar pregnancies, making them important diagnostic indicators. Clinical symptoms, including vaginal bleeding (64.5%) and lower abdominal pain (71%), are also frequently observed, reinforcing their significance in early detection. The study also identifies partial moles (77.4%) as the most common type of molar pregnancy, with complete moles (22.6%) being less frequent. Overall, the findings suggest that molar pregnancies are 2

  17. diagnosed through a combination of clinical symptoms and ultrasound indicators, with specific features such as cystic lesions and enlarged uterus being strongly associated with the condition. Conclusions: Ultrasound is a key tool for early detection of molar pregnancies, with cystic lesions and an enlarged uterus as prominent indicators. While more common in younger women, advanced maternal age also showed significant correlation. Partial moles were predominant, with clinical symptoms aiding timely diagnosis. Keywords: Complete mole (CM), Partial mole (PM), maternal age, Vaginal Bleeding, Snowstorm pattern, prenatal diagnosis. 4

  18. Chapter 1 INTRODUCTION A molar pregnancy, or hydatidiform mole, is a rare form of gestational trophoblastic disease (GTD) characterized by abnormal trophoblastic proliferation and atypical development of placental tissue. Instead of a normal embryo, this pathological pregnancy results in the growth of vesicular, cystic structures within the uterus. There are two major subtypes of molar pregnancies: complete and partial moles. A complete molar pregnancy involves the fertilization of an ovum that lacks maternal genetic material, leading to abnormal placental growth with no embryonic tissue. In contrast, a partial mole occurs when a normal ovum is fertilized by two sperm, resulting in triploidy and abnormal embryonic development alongside hydropic changes in the placental villi1. Molar pregnancies are relatively rare, with global incidence rates varying from 1 in 468 to 1 in 714 pregnancies2. However, prevalence rates tend to be higher in specific geographic and ethnic populations, with increased susceptibility in Asian women and women from lower socio-economic backgrounds3. Despite their rarity, molar pregnancies pose significant risks to maternal health due to the potential progression to persistent GTD or even choriocarcinoma if left undiagnosed or untreated. Timely identification of molar pregnancy is crucial for optimal maternal outcomes. Delayed diagnosis can result in hemorrhagic complications, uterine perforation, or malignant transformation. The first trimester is the most critical window for identifying these pregnancies, which often present non-specific symptoms such as vaginal bleeding, uterine enlargement, or excessive nausea and vomiting. Consequently, imaging modalities, especially ultrasonography, play a central role in the early recognition and classification of molar pregnancies4. Ultrasound imaging is the primary diagnostic tool used to assess abnormal pregnancies. The classic "snowstorm" or "cluster of grapes" appearance on transvaginal ultrasound is often associated with complete molar pregnancy, whereas partial moles may show a gestational sac with fetal tissue and cystic changes in the placenta5. Early sonographic evaluation allows for appropriate clinical management and avoids complications related to missed or delayed diagnoses. 5

  19. Figure 1.1 Figure 1.2 Figure 1.1 and 1.2 shows multiple anechoic (black) cystic spaces of varying size are seen within the uterus. Ultrasound serves as the frontline imaging modality for evaluating first-trimester pregnancies suspected to be molar in nature. Its ability to provide detailed visualization of the intrauterine contents makes it particularly valuable in differentiating between normal pregnancies, miscarriages, and molar pregnancies. In complete moles, the sonographic hallmark is a heterogeneous mass with numerous anechoic cystic spaces (representing swollen villi), and the absence of fetal tissue. In contrast, partial moles may demonstrate a malformed fetus along with an abnormal, enlarged placenta containing cystic areas6. 6

  20. In addition to grayscale imaging, Doppler ultrasound may be employed to evaluate the vascular flow patterns within the trophoblastic tissue. Increased vascularity may suggest higher risk of persistent GTD and necessitate more aggressive follow-up7. Moreover, ultrasound allows for stratification of patients based on the risk of complications, guiding decisions regarding surgical evacuation versus medical management. Figure 1.3 Figure 1.3 shows multiple cystic spaces in transvaginal ultrasound resembling a “bunch of grapes,” suggestive of molar pregnancy. Maternal age has long been recognized as a risk factor for molar pregnancies. Research has consistently demonstrated a bimodal distribution, with higher incidence seen among women younger than 20 and older than 35. In younger women, particularly those aged 20–28, partial moles are more common, often due to triploidy resulting from dispermic fertilization. In contrast, complete moles are more frequently encountered in women over 38, which is thought to result from chromosomal anomalies associated with aging oocytes. In the present study, a majority of molar pregnancies were observed in women aged 21–28 (45.2%), followed by those over 38 years (32.3%). This trend aligns with prior literature suggesting age-related susceptibility to specific mole types. Advanced maternal age is also associated with 7

  21. increased chromosomal miss aggregation during meiosis, thereby increasing the risk of abnormal conceptions such as complete moles. The clinical presentation of molar pregnancy is often varied but typically includes symptoms such as vaginal bleeding, excessive uterine size, severe nausea and vomiting (hyperemesis gravidarum), and, occasionally, signs of early-onset preeclampsia or hyperthyroidism. In this study, the most reported clinical symptoms were lower abdominal pain (71%) and vaginal bleeding (64.5%). These symptoms were often accompanied by distinctive ultrasound findings such as cystic lesions (64.5%) and an enlarged uterus (67.7%). Such data underscore the importance of integrating clinical and sonographic findings to arrive at a timely diagnosis. Early detection facilitates swift intervention, including uterine evacuation and follow-up monitoring through serial β-hCG levels, to ensure complete resolution of trophoblastic tissue and reduce the risk of persistent disease. From a molecular perspective, molar pregnancies are often associated with aberrations in parental genomic imprinting and chromosomal triploidy. Complete moles usually have a diploid karyotype consisting entirely of paternal chromosomes (46, XX or 46, XY), due to fertilization of an empty ovum by a single sperm that subsequently duplicates. Partial moles, on the other hand, exhibit triploid karyotypes (69, XXY or 69, XXX) resulting from dual sperm fertilization of a single ovum. Genetic mutations in maternal genes such as NLRP7 and KHDC3L have also been implicated in recurrent molar pregnancies. These findings highlight the importance of considering genetic counseling and advanced molecular diagnostics in women with repeated molar gestation. Despite the known association between maternal age and molar pregnancy risk, limited local studies have investigated the sonographic presentation of molar pregnancies across different maternal age groups in a Pakistani context. This study seeks to bridge that gap by evaluating 31 patients in the first trimester with suspected abnormal pregnancies, correlating ultrasound features with age categories. By identifying key diagnostic ultrasound features and stratifying patients by maternal age, the study enhances understanding of risk profiles and reinforces the importance of routine first-trimester ultrasound in high-risk populations. It also aims to assist clinicians in making informed decisions about early intervention and follow-up monitoring, thus reducing maternal morbidity. 8

  22. CHAPTER 2 LITERATURE REVIEW Ross et al., 2018 conducted study on ultrasound diagnosis of molar pregnancy. One hundred eighty-two women included in this study 106/182 (58.2%, 95 percent CI 51.0 to 65.2%) had gestational trophoblastic disease that was histologically confirmed (1:360, 0.3%) on ultrasound examination. The likelihood ratio for gestational trophoblastic disease after a positive ultrasound was 607.27, with a post-test probability of 0.628. The sensitivity of ultrasound for gestational trophoblastic disease was 70.7% (95% CI 62.9% to 77.4%) with an estimated specificity of 99.88% (95% CI 99.85% to 99.91%); 102/143 (71.3%, 95% CI 63.4 to 78.1%) molar pregnancies were suspected on pre-op ultrasound; 60/68 (88.2%, 95% CI 78.2 to 94.2%) of complete moles were suspected on pre-op ultrasound, compared with 42/75 (56.0%, 95% CI 44.7 to 66.7%) of partial moles. On retrospective review of the pre-op ultrasound images, there were cases that could have been suspected prior to surgery. It is still difficult to diagnose molar pregnancy using ultrasound, particularly for partial moles. These data suggest that there has been an increase in both the predictive value and the sensitivity of ultrasound over time, with a high LR and post-test probability; however, the diagnostic criteria remain ill-defined and could be improved8. Johns et al., 2005 conducted a prospective study of ultrasound screening for molar pregnancies in missed miscarriages was carried out by Johns et al. in 2005. Gynecological and Obstetric Ultrasound. Five cases were later removed from the final analysis due to the diagnosis of hydropic abortion (HA), out of 51 cases of suspected molar pregnancy that were referred to the regional center for additional histological opinion and follow-up. On the first scan, a molar pregnancy was suspected in 33 cases. Out of these, 26 (78.8%) were confirmed by histology, meaning that ultrasound alone had a 56% detection rate. Nine of the fifteen cases with available hCG results were greater than two multiples of the median. It is challenging to diagnose partial (PHM) and complete (CHM) hydatidiform moles in first-trimester miscarriages. hCG is much greater9. 9

  23. Sahoo et al., 2017 conducted a study on the early ultrasound diagnosis and follow-up of molar pregnancies. Examining the role of ultrasound in the differential diagnosis and treatment of early pregnancies exhibiting placental molar changes was the aim of this study on ultrasound in obstetrics and gynecology. Women who underwent ultrasound examinations between weeks 10 and 14 of pregnancy had their placental characteristics documented over a 10-month period. When a molar pregnancy occurred, the fetal karyotype was determined in utero. If the pregnancy proceeded, serial measurements of the mother's hCG concentration and uterine artery resistance to flow were made. Following delivery, a histopathological analysis of the placenta was carried out in every instance. Over the course of the study, 9425 women received an early scan and one classical mole, four hydatidiform moles coexisting with a normal pregnancy, three partial triploid moles, and three partial moles connected in one instance to a fetus exhibiting congenital abnormalities indicative of Beckwith-Widemann syndrome were among the eleven molar pregnancies that were found. The hCG levels were elevated throughout the remainder of the pregnancy in cases of hydatidiform moles coexisting with a fetus, with the exception of one triploidy case. The uterine artery resistance was normal in these instances. According to the available data, placental ultrasound examination can accurately detect molar changes in the early stages of pregnancy. When combined with uterine Doppler measurements and hCG levels, it can also establish the differential diagnosis of the different types of placental molar transformations in utero10. Bakhtawar et al., 2022 conducted a study on ultrasound diagnosis and risk factors for first-trimester pregnancy complications was carried out by Bakhtawar et al. in 2022. Incomplete abortion (29, 48.3%) after missed abortion (17, 28.3%) was the most frequent complication in the first trimester, according to ultrasound diagnosis and risk factors for the first trimester. Gravidity, parity, abortions, fibroids, trauma, and molar pregnancy were the risk factors that led to complications. The largest proportion of patients (30, 50%) with complications are in the 30- to 39-year-old age range. Age 30 (50%) and trauma 18 (30%) were the most common risk factors for complications, along with gravidities of G4 (14, 23.3%) and G2 (10, 16.7%) and parity P1 (19 patients, 31.7%) and P2 (14 patients, 23.3%). In conclusion, older, nulliparous females had a higher incidence of complications, whereas females with less Complications were found to be more common in patients with a history of vaginal bleeding and abdominal pain. Women with poor obstetrical histories who are nulliparous or multiparous are particularly vulnerable. Transvaginal ultrasonography is a very useful diagnostic tool for missed abortions and ectopic pregnancies11. 10

  24. Vasa et al., 2025 conducted study on sonographic appearance of early complete molar pregnancies. Journal of ultrasound in medicine to evaluate our anecdotal experience indicates that the classically described "snowstorm" appearance on ultrasonography of early molar pregnancies is often not present and that theca-lutein cysts are also rare, we examined the ultrasonographic appearance of early complete molar pregnancies. We reviewed the ultrasonographic reports and clinical data of 21 cases of histologically diagnosed complete molar pregnancies with a mean gestational age at sonography of 10.5 weeks (range, 4 to 18 weeks). The diagnosis of molar pregnancy was made on ultrasonography in 12 (57%) cases, was second in the differential diagnosis of one (4.8%) case, and was not considered in eight (38%) cases. No theca- lutein cysts were identified. Five of five (100%) molar pregnancies of 13 weeks or over were diagnosed prospectively, while only eight of 16 (50%) earlier pregnancies were correctly diagnosed prospectively. In a retrospective review of the available images of 16 patients, only nine of 16 (56%) images demonstrated the classic appearance, and no theca-lutein cysts were seen. This conclude that the classic appearance of complete moles on ultrasonography is seen in less than two thirds of cases and even less commonly in the first trimester. The prevalence of theca-lutein cyst is very low12were identified. Five of five (100%) molar pregnancies of 13 weeks or over were diagnosed prospectively, while only eight of 16 (50%) earlier pregnancies were correctly diagnosed prospectively. In a retrospective review of the available images of 16 patients, only nine of 16 (56%) images demonstrated the classic appearance, and no theca-lutein cysts were seen. This conclude that the classic appearance of complete moles on ultrasonography is seen in less than two thirds of cases and even less commonly in the first trimester. The prevalence of theca-lutein cyst is very low12. Zhao et al., 2024 conducted a study on the diagnostic implications of routine ultrasound examination in histologically confirmed early molar pregnancies. There were 155 cases with a reviewed histological diagnosis of complete or partial hydatidiform mole. In 131 (67%) cases, the sonographic diagnosis was that of a missed miscarriage/anembryonic pregnancy with no documented suspicion of molar pregnancy, referral being on the basis of histological examination of products of conception. In 63 cases, ultrasound examination suggested molar pregnancy; in 53 (84%) of these, the diagnosis of molar pregnancy was correct. Overall, 37 of 64 (58%) 11

  25. complete moles had sonographic evidence of molar pregnancy compared to 16 of 91 (17%) partial moles. Of 155 histologically confirmed complete or partial hydatidiform moles, only 53 (34%) were suspected as molar sonographically. The majority of cases of molar pregnancy now present as missed miscarriage/anembryonic pregnancy. Sonographically, highlighting the importance of histological examination to diagnose gestational trophoblastic disease13. Vural et al., 2025 conducted study on the changing clinical presentation of complete molar pregnancy. Obstetrics & Gynecology to evaluate the vaginal bleeding remained the most common presenting symptom, occurring in 62 of 74 (84%) current patients, compared with 297 of 306 (97%) controls (P = .001). However, anemia was present in only four of 74 (5%) current patients, compared with 165 of 306 (54%) controls (P = .001). Excessive uterine size, preeclampsia, and hyperemesis occurred in only 21 of 74 (28%), one of 74 (1.3%), and six of 74 (8%) current patients, respectively, compared with 156 of 306 (51%), 83 of 306 (27%), and 80 of 306 (26%), respectively, of historic controls (P = .001). No cases of clinical hyperthyroidism or respiratory distress were found in recent years. Ultrasound diagnosed complete hydatidiform mole before the onset of clinical symptoms in seven of 69 (10%) current patients. Among patients not receiving chemoprophylaxis, persistent gestational trophoblastic tumor developed in 23% of current patients and 18.6% of historic controls. Fewer current patients with complete hydatidiform mole present with the traditional symptoms of complete hydatidiform mole (excessive uterine size, anemia, preeclampsia, hyperthyroidism, or hyperemesis) when compared with historic controls. However, there has been no statistically significant change in the development of persistent gestational trophoblastic tumor in current patients compared with historic controls14. Elias et al., 2024 conducted a study on Gestational trophoblastic disease (GTD) is subclassified into hydatidiform mole (HM), gestational trophoblastic tumors (GTT) and non-neoplastic trophoblastic lesions. HM, partial and complete, originate from villous trophoblast and are considered as preneoplastic conditions. The risk for the development of persistent GTD, mostly as invasive HM, ranges from 0.5% to 20%, which depends on the type of molar pregnancy. The risk of development of trophoblastic tumour after PHM is <0.5% and 2%–3% after CHM. GTT represent a spectrum of neoplasms that originates from the intermediate, largely extravillous, trophoblast and these include choriocarcinoma (CC), placental site trophoblastic 12

  26. tumour (PSTT), epithelioid trophoblastic tumour (ETT) and mixed trophoblastic tumour. Among tumour like conditions, exaggerated placental site reaction (EPSR) and placental site nodule (PSN) (s)/plaque (s) are included. The morphological appearances of HM can be mimicked by abnormal (non-molar) villous lesions, and similarly, GTT can be mimicked both by non-malignant tumour-like conditions and non-gestational tumors with trophoblastic differentiation, which add to the diagnostic dilemma of these rare conditions. GTT have a favorable prognosis and better response to specific chemotherapeutic regimens when compared with non-gestational malignant genital tract neoplasms. The correct diagnosis and classification of these rare conditions are therefore important. This article focusses on the morphological appearances, immunocytochemistry as an aid in the diagnosis and the changes in current WHO classification of GTDs (WHO 2020)15. Elias et al., 2024 conducted a study on all cases of first histologically confirmed complete and partial moles registered between 1985 and 1999 were identified from the database of a trophoblastic disease Registration Centre. The maternal age distribution at diagnosis was calculated for the 7916 molar pregnancies and compared with the maternal age distribution of an unselected population of women from a routine obstetrics database. Likelihood ratios were calculated for complete and partial molar pregnancies by maternal age. A positive relationship was found between the risk of molar pregnancy and both upper and lower extremes of maternal age (≥45 years and ≤15 years, respectively). This association, although present for both complete and partial moles, is much greater for complete mole at all maternal ages, and the degree of risk is much greater with older (≥45 years) rather than younger (≤15 years) maternal age. This study provides, for the first time, data regarding specific risk of partial versus complete hydatidiform mole with maternal age16. Elias et al., 2024 conducted a study on of 2578 complete moles, the subsequent pregnancy was affected by hydatidiform mole in 27 (1.9%) cases, including 22 (81%) complete moles and 5 (19%) partial moles. Of 2627 partial moles, the subsequent pregnancy was also molar in 25 (1.7%) cases, including 17 (68%) partial moles and 8 (32%) complete moles. Overall recurrence risk for molar pregnancy was 1.8% (1 in 55), or a 20-fold increase compared with the background risk. Of 27 cases with repeat complete moles, three had further complete moles, suggesting the recurrence risk following two previous complete moles is approximately 10%. There were no other 13

  27. significant differences in pregnancy outcome between cases with previous complete or partial hydatidiform mole and that expected in an unselected obstetric population17. Ip et al., 2024 conducted a study on the risk of gestational trophoblastic disease in relation to frequency of consumption of selected dietary items was evaluated with data from a case-control study conducted in Northern Italy on 148 women with histologically confirmed gestational trophoblastic disease and two control groups, one consisting of 372 obstetric control subjects and one consisting of 406 patients in the hospital for acute, nonobstetric, nongynecologic conditions. Patients with gestational trophoblastic disease tended to consume several foods less frequently, including the major sources of vitamin A and animal protein in the Italian diet. Relative risk estimates were significantly below unity in both control groups for green vegetable, carrot, liver, and cheese consumption and in the obstetric control group only for milk, meat, eggs, fresh fruit, and fish. Inverse relationships emerged between the risk of gestational trophoblastic disease and β-carotene or retinol intake index. The trend of decreasing risk with increasing intake was significant for β-carotene consumption. The present findings confirm that various aspects of diet may influence the risk of gestational trophoblastic disease. However, the limitation of available evidence still introduces serious uncertainties in the interpretation of these findings and suggests the potential importance of further epidemiologic and biochemical research to obtain more precise definition of specific dietary correlates of gestational trophoblastic disease 18. Aguedo et al., 2025 conducted a study on Gestational trophoblastic disease encompasses a range of pregnancy-related disorders, consisting of the premalignant disorders of complete and partial hydatidiform mole, and the malignant disorders of invasive mole, choriocarcinoma, and the rare placental-site trophoblastic tumour. These malignant forms are termed gestational trophoblastic tumors or neoplasia. Improvements in management and follow-up protocols mean that overall cure rates can exceed 98% with fertility retention, whereas most women would have died from malignant disease 60 years ago. This success can be explained by the development of effective treatments, the use of human chorionic gonadotropin as a biomarker, and centralisation of care. We summarize strategies for management of gestational trophoblastic disease and address some of the controversies and future research directions19. 14

  28. Gupta et al., 2025 to describe the clinical features, treatment and outcome of all consecutive patients with placental site trophoblastic tumor (PSTT) treated at the Sheffield Trophoblast Centre and to compare these findings to other reports. All cases of PSTT on the Sheffield Trophoblastic Tumour Centre database from 1984 to 2004 were reviewed. Data obtained included age at diagnosis, antecedent pregnancy (AP), interval from antecedent pregnancy until diagnosis, presenting features, presenting serum human chorionic gonadotrophin hormone (hCG) level, number and sites of metastases, treatment received, outcome and follow-up. Seventeen patients with PSTT were identified from the database which incorporates a total of 7489 cases of trophoblastic disease. Fourteen (70.6%) were more than 30 years old at presentation; 5 were over 40. The median interval from pregnancy to diagnosis was 18 months (range 6 months to 22 years). The outcome of antecedent pregnancy was a female in 11 out of the 13 patients where the sex was known. Eleven (70.6%) of patients presented with irregular vaginal bleeding, with or without a preceding period of amenorrhea. All 8 patients with non-metastatic (Stage I) disease were alive and well after hysterectomy, chemotherapy alone or hysterectomy and chemotherapy whereas only 4 of 9 patients with metastatic (Stage III/IV) disease were alive and well after treatment with chemotherapy and hysterectomy20. Joyce et al., 2025 conducted a study on 11 patients registered with an initial diagnosis of partial hydatidiform mole (PHM) subsequently required chemotherapy for a gestational trophoblastic tumour. In a retrospective review by histopathological examination and measurement of DNA ploidy, the diagnosis was confirmed as PHM in 5 cases and revised to complete hydatidiform mole in 4; in 2 cases there was no evidence of a molar pregnancy. 4 of the patients with PHM had no other known pregnancy before the gestational trophoblastic tumour and in 2 of these patients the tumour was diagnosed histologically as choriocarcinoma. Not all patients in whom PHM was diagnosed at referring hospitals proved to have the condition. Although the risk of a patient with PHM requiring chemotherapy for gestational trophoblastic tumour is of the order of 1 in 200, compared with 1 in 12 after a complete mole, there is no justification for excluding a patient from follow-up after the evacuation of a PHM21. Joyce et al., 2025 conducted a study was designed to investigate the genetic origin of hydatidiform moles. Fifty-nine specimens were obtained and, on a histological basis, 15

  29. separated into two entities: complete and partial. The study of the genetic origin of the 15 partial moles, using cytogenetic and biochemical markers, is described. All the partial moles examined cytogenetically were triploid. One had 71 chromosomes. The sex chromosome complements of seven cases were six XXY and one XXX. Origin by dispermy was possible in seven cases and was proven in four. With the use of biochemical marker a maternal contribution was identified in three cases, and the isoenzyme pattern suggested a trisomic state for at least one locus in four cases. The mechanism of origin of partial moles was compared with spontaneously aborted and liveborn triploids. All the patients were followed up for at least 9 months, and none required treatment for persistent trophoblastic activity22. Joyce et al., 2025 to determine an elective study of 163 hydatidiform moles 38 were classified as partial mole (PHM) and 125 as complete mole (CHM) on the basis of pathology. Genetic studies showed the PHM to be triploid with one maternal and two paternal chromosome sets. In all cases of PHM, the molar pregnancy resolved spontaneously after evacuation. On the basis of genetic studies CHM which were diploid could be subdivided into two entities: homozygous androgenetic CHMs that were 46XX, and heterozygous CHMs which were androgenetic and usually 46XY. In informative cases in this series the frequency of heterozygous CHM was 10 per cent. Twenty-two (17.6 per cent) of all the patients with CHM required subsequent chemotherapy for post-mole trophoblastic tumor. Where patients with CHM could be classified as having homozygous or heterozygous CHM the requirement for treatment (17.8 per cent and 25 per cent, respectively) was not found to be significantly different in the two groups23. Walbum et al., 2024 to determine hydatidiform moles studied with respect to cytogenetics and morphologic constitution were divisible into two syndromes: (1) complete, classical mole giving a 46 XX karyotype and (2) partial mole with an ascertainable embryo/fetus, dead or alive, giving a triploid karyotype. The complete moles undergo early and total hydatidiform change from edema to central cistern formation, the embryos proper having perished before the establishment of a functioning circulation. Trophoblastic hyperplasia is conspicuous and the connection of this group to choriocarcinoma is well established. In the partial moles there is a slow hydatidiform change that affects only some of the villi, but which seems to follow along the same lines as in complete moles. There is focal moderate trophoblastic 16

  30. hyperplasia, villous “trophoblastic inclusions” (that appear in triploids only), and maze-like central cisterns in the later cases. The partial mole, 46 XX, partakes of morphologic characteristics of both main syndromes and may represent an unusual syndrome of its own. The two main syndromes can now be distinguished morphologically and the question of the association of the partial mole with choriocarcinoma has now to be further studied24. Soto-Wright V et al.2018 conducted study to evaluate the vaginal bleeding remained the most common presenting symptom, occurring in 62 of 74 (84%) current patients, compared with 297 of 306 (97%) controls (P = .001). However, anemia was present in only four of 74 (5%) current patients, compared with 165 of 306 (54%) controls (P = .001). Excessive uterine size, preeclampsia, and hyperemesis occurred in only 21 of 74 (28%), one of 74 (1.3%), and six of 74 (8%) current patients, respectively, compared with 156 of 306 (51%), 83 of 306 (27%), and 80 of 306 (26%), respectively, of historic controls (P = .001). No cases of clinical hyperthyroidism or respiratory distress were found in recent years. Ultrasound diagnosed complete hydatidiform mole before the onset of clinical symptoms in seven of 69 (10%) current patients. Among patients not receiving chemoprophylaxis, persistent gestational trophoblastic tumor developed in 23% of current patients and 18.6% of historic controls. Fewer current patients with complete hydatidiform mole present with the traditional symptoms of complete hydatidiform mole (excessive uterine size, anemia, preeclampsia, hyperthyroidism, or hyperemesis) when compared with historic controls. However, there has been no statistically significant change in the development of persistent gestational trophoblastic tumor in current patients compared with historic controls25. Bakhtawar Ket., el in 2012 conducted study to evaluate the most common complication in 1st trimester was incomplete abortion (29, 48.3%) following missed abortion 17(28.3%). The risk factors causing complications were gravidity, parity, abortions, fibroids, trauma, and molar pregnancy. The age group of 30-39 years has the maximum number of patients (30, 50%) diagnosed with complications. The common risk factor causing complication was due to age 30(50%), trauma 18(30%), gravidities were G4 (14, 23.3%) and G2 (10, 16.7%) and parity P1 (19 patients, 31.7%) and P2 (14 patients, 23.3%). In conclusion, the incidence of complication increased 17

  31. in nulliparous, aged females and decreased in females having less gravidity. Patients with a history of abdominal pain and vaginal bleeding were noticed to have a higher incidence of complications. Nulliparous and multiparous women having poor obstetrical history are at high risk. Transvaginal ultrasound is very effective in diagnosing ectopic pregnancy and missed abortion26. Johns J et al., 2014 conducted study to evaluate Fifty-one cases of suspected molar pregnancy were referred to the regional center for further histological opinion and follow-up, and five cases were subsequently excluded from the final analysis because of the diagnosis of hydropic abortion (HA). In 33 cases a molar pregnancy was suspected at the initial scan. Of these, 26 (78.8%) were confirmed on histology, resulting in a 56% detection rate using ultrasound alone. In 15 cases hCG results were available, of which nine were greater than two multiples of the median. The diagnosis of both complete (CHM) and partial (PHM) hydatidiform moles in first-trimester miscarriages is difficult. hCG is significantly higher in both CHM and PHM and, in conjunction with transvaginal ultrasound, could provide the screening test required to enable clinicians to counsel women more confidently towards non-surgical methods of management of their miscarriage, were histopathological examination27. Jauniaux E et el., 2017 conducted study to evaluate the objective of this study was to investigate the role of ultrasound in the differential diagnosis and management of early pregnancies presenting with placental molar changes. Placental features were recorded over a 10-month period in women undergoing ultrasound examination at 10–14 weeks of gestation. In cases of a molar pregnancy, the fetal karyotype was obtained in utero and, if tbe pregnancy continued, the maternal concentration of human chorionic gonadotropin (hCG) and uterine artery resistance to flow were measured serially. A histopathological examination of the placenta was performed in all cases after delivery. During the study period, 9425 women had an early scan and 11 molar pregnancies were identified including one classical mole, four hydatidiform moles coexisting with a normal pregnancy, three partial triploid moles and three partial moles associated in one case with a fetus presenting congenital anomalies diagnostic of Beckwith– Wiedemann syndrome. The hCG levels were high in all cases except one case of triploidy and remained high during the rest of the pregnancy in cases of hydatidiform moles coexisting with a fetus. In these cases, the uterine artery resistance was normal. The present data indicate that placental ultrasound examination can 18

  32. correctly identify molar changes in early pregnancy and together with hCG level and uterine Doppler measurements can establish the differential diagnosis in utero of the various forms of placental molar transformations28. SB Iftikhar et el,.2024 conducted a study to determine the incidence of molar pregnancies among women who give birth at Jinnah Hospital in Lahore and to determine various risk factors for molar pregnancy. The research method was a cross- sectional analysis. It occurred in Jinnah Hospital's obstetrics and Gynaecology department in Lahore. The research was conducted over the course of six months, from March 6, 2021, to December 2, 2021. 145 people were enrolled in the research. A transvaginal ultrasound was performed on all of the patients, and molar pregnancy and its associated dangers were documented. Mean age of the patients was 30.8±6.6 years; mean gestational age was 13.3±2.3 week. Majority were multigravida 87 (60%) while 58 (40%) were primigravida. Molar pregnancy was found in 10 cases (6.9%). With advanced maternal age 21% with molar pregnancy, whereas history of previous miscarriage and use of oral contraceptive pills was present in 69.2% and 23% of females with molar pregnancy respectively29. A Patel et el,.2024 conducted a study to evaluate vaginal bleeding during early pregnancy is a common condition. It is associated with an underlying abnormality, which often is a serious cause requiring emergency management. Clinical diagnosis in such cases is mostly nonconclusive, and ultrasound (both abdominal and transvaginal), a valuable and easily available tool, is required to identify the cause and guide the clinician in choosing the appropriate line of management. With the objective of evaluating patients presenting with vaginal bleeding in early pregnancy, this study was conducted in the Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Hospital, Jaipur, for a period of 1.5 years. All cases with first- trimester vaginal bleeding were selected, and clinical diagnosis was confirmed by ultrasonography (USG). A total of 728 patients with first-trimester bleeding were evaluated. The most common clinical diagnosis was threatened abortion. Out of 505 cases of threatened abortion diagnosed clinically, ultrasound confirmed threatened abortion in 340 cases only. In the rest of these cases, the diagnosis was complete abortion in 24, missed abortion in 85, tubal ectopic in 7, and in one case, a vesicular mole was diagnosed. Eleven cases of arteriovenous malformation and eight cases of scar pregnancy, both requiring specific management, were observed only by 19

  33. ultrasound. The study highlights the importance of USG, which plays an important role in evaluation of the causes of first-trimester bleeding, prognosticate and predict the status of abnormal pregnancies30. KM Elias et., el 2023 conducted a study that ultrasound plays an important role in the diagnosis and management of patients with gestational trophoblastic disease (GTD), including molar pregnancy and gestational trophoblastic neoplasia (GTN). The initial diagnosis of complete hydatidiform mole (CHM) is generally made with a markedly elevated human chorionic gonadotropin (hCG) and an abnormal ultrasound, which exhibits the classic snowstorm or grapelike appearance of the hydropic villi. The initial diagnosis of partial hydatidiform mole (PHM) by ultrasound in early pregnancy is less reliable. Overall, ultrasound is 34–57% sensitive in diagnosing molar pregnancy in the first trimester. The use of transvaginal ultrasound and color Doppler enhances the ability to assess the presence and extent of intrauterine disease in patients with GTN. Ultrasound measurement of uterine artery pulsations is predictive of the need for chemotherapy and may provide an indication of chemosensitivity in the management of patients. Furthermore, ultrasound is useful for the long-term follow-up of patients with GTD who develop abnormal bleeding following treatment to identify persistent disease, a new pregnancy event, or arteriovenous malformations. Lastly, ultrasound is essential in evaluating subsequent pregnancies to exclude recurrent GTD31. 20

  34. CHAPTER 3 OBJECTIVE Role of ultrasound in identifying molar pregnancies in first trimester and its correlation with maternal age. 21

  35. 3.2 PROBLEM STATEMENT Molar pregnancies often go undiagnosed in the first trimester due to subtle or absent symptoms, leading to potential complications. While ultrasound is a key diagnostic tool, its role in identifying early risk factors such as abnormal trophoblastic tissue growth and uterine changes remains insufficiently understood. 22

  36. 3.3 OPERATIONAL DEFINITIONS Molar Pregnancy: A molar pregnancy is a type of gestational trophoblastic disease where abnormal growth of trophoblastic tissue occurs instead of a normal embryo. It may manifest as a complete or partial mole, characterized by cystic structures in the uterus. The condition can lead to complications such as persistent trophoblastic disease or malignancy if untreated32. Ultrasound: Ultrasound imaging has a high sensitivity (up to 90%) for detecting molar pregnancies in the first trimester, especially for complete molar pregnancies, characterized by the classic "snowstorm" pattern. The specificity of ultrasound in diagnosing molar pregnancies can vary depending on the expertise of the practitioner and the quality of the imaging equipment, but it is generally considered an effective tool for early diagnosis33. Miscarriage Miscarriage, also known as pregnancy loss or spontaneous abortion, is the term most frequently used to describe a nonviable intrauterine pregnancy up to 20 weeks of gestation34. 23

  37. CHAPTER 4 MATERIAL AND METHODS 4.1 Study Design: Descriptive Cross Sectional study. 4.2 Settings: MAYO Hospital Lahore. 4.3 Duration of Study: 3 months after approval of synopsis. 4.4 Sample Size: N=3135 4.5 Sampling Technique: Convenient sampling technique. 4.6 Sample Selection: 4.6.1 Inclusion Criteria: Pregnant women in their first trimester. With or without vaginal bleeding. Discharge with grape like vesicles. 4.7 Exclusion Criteria: Women with multiple pregnancies (e.g., twins, triplets). Uncontrolled diabetes. Hypertension. Previous History of gestational trophoblastic disease. 4.8 Equipment: Curvilinear Probe typically operate at lower frequencies, generally between3.5 to 5 MHz. 24

  38. 4.9 Scanning Technique: Transabdominal Ultrasound (TAS) as the primary imaging technique for detecting molar pregnancies in the first trimester. Patients were positioned supine with a full bladder to optimize imaging clarity, and ultrasound gel was applied to the abdomen to ensure proper sound wave transmission. A curved array transabdominal probe (3.5 to 5 MHz) was used to scan the uterus from the pubic symphysis to the upper abdomen, capturing both sagittal and transverse views. Key ultrasound markers, such as the snowstorm pattern in complete moles and cystic changes in partial moles, will be closely assessed. The size and shape of the uterus was measured, noting any enlargement or abnormal tissue growth. Additional signs, including ovarian theca lutein cysts, will also be examined. Dynamic imaging were employed to capture comprehensive data, and 3D imaging will be considered where available. 25

  39. 4.10 ETHICAL CONSIDERATIONS The rules and regulations set by the ethical committee of Superior University, Lahore will be followed while conducting the research and the rights of the research participants will be respected. Written informed consent (attached) will be taken from all the participants. All information and data collection will be kept confidential. Participants will remain anonymous throughout the study. The subjects will be informed that there are no disadvantages or risks on the procedure of the study. They will also be informed that they will be free to withdraw at any time during the process of the study. There will be no any known risks associated with this research. There will be benefits to the participant that would result from their participation in this research. We will do everything we can to protect your privacy. Your identity will not be revealed in any publication resulting from this study. Your participation in this research study is voluntary. You may choose not to participate and you may withdraw your consent to participate any time. You will not be penalized in any way should you decide not you participate or to withdraw from this study. 26

  40. 4.11 DATA COLLECTION PROCEDURE Patients in their first trimester were recruited from the Department of Obstetrics and Gynecology at Mayo Hospital, Lahore, based on strict inclusion and exclusion criteria to ensure diagnostic accuracy. After obtaining informed consent, a thorough obstetric history was documented, including details of previous pregnancies, miscarriages, and gestational age. Each participant underwent a transabdominal ultrasound (TAS) using a 3.5–5 MHz curved array probe, performed by trained radiologists. During the scan, sonographic features such as uterine size, snowstorm pattern, cystic placental structures, and fetal viability were assessed and recorded. The presence of theca lutein cysts and embryonic anomalies was also noted to support differential diagnosis. All findings were entered into a standardized data sheet to maintain consistency and minimize observer bias. Ethical clearance was obtained prior to data collection, and patient confidentiality was strictly maintained throughout the study. 27

  41. 4.12 DATA ANALYSIS PROCEDURE The collected data were statistically analyzed using SPSS version 26.0. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize patient demographics and ultrasound findings. The Chi-square test assessed relationships between categorical variables, such as the presence of molar features on ultrasound and diagnosis type (complete or partial mole). The independent t-test compared the mean uterine sizes between molar and non-molar pregnancies to identify significant size differences. A significance threshold of p < 0.05 was set to determine statistical relevance. This analytical approach helped to validate ultrasound as a diagnostic tool and to understand the relationship between maternal age and specific sonographic patterns. 28

  42. CHAPTER 5 RESULTS Table 5.1 Of Maternal Age Group Maternal Age Group Frequency Percent Age Group 21-28 14 45.2 Age Group 29-37 7 22.6 Age group >38 10 32.3 Total 31 100.0 The study sample (N = 31) was categorized into three maternal age groups to assess the age-related distribution of molar pregnancy cases. The largest proportion of participants, 45.2% (n = 14), belonged to the 21–28 years age group. 22.6% (n = 7) were in the 29–37 years age group. 32.3% (n = 10) were aged 38 years or older. This distribution indicates that younger women (21–28 years) represented the highest percentage of molar pregnancy cases in this sample. However, a notable proportion (32.3%) of cases were also observed in women over 38, supporting existing evidence that advanced maternal age is a recognized risk factor for molar pregnancy. 29

  43. Table 5.2 of Lace Like Pattern Lace Like Pattern Frequency Percent Absent 16 51.6 Present 15 48.4 Total 31 100.0 Among the 31 cases examined, the lace-like pattern—a potential ultrasound indicator of molar pregnancy—was observed with the following distribution: 48.4% (n = 15) of patients showed the presence of a lace-like pattern. 51.6% (n = 16) of patients did not exhibit this feature. This suggests that the lace-like pattern was present in nearly half of the cases. While not universally observed, its substantial occurrence indicates it may be a useful but not definitive diagnostic marker in early evaluation of molar pregnancy. 30

  44. Table 5.3 Of Cystic Lesion Cystic Lesion Frequency Percent Absent 11 35.5 Present 20 64.5 Total 31 100.0 Out of 31 patients evaluated: 64.5% (n = 20) demonstrated the presence of cystic lesions on ultrasound. 35.5% (n = 11) had no cystic lesions observed. This shows that cystic lesions were the most commonly identified ultrasound feature in the sample, present in nearly two-thirds of the cases. Their frequent occurrence supports their role as a significant diagnostic indicator in suspected molar pregnancies and highlights the importance of early sonographic assessment. 31

  45. Table 5.4 of Enlarged Uterus Enlarged Uterus Frequency Percent Absent 10 32.3 Present 21 67.7 Total 31 100.0 In the analysis of 31 cases: 67.7% (n = 21) of patients had an enlarged uterus noted on ultrasound. 32.3% (n = 10) showed no uterine enlargement. This indicates that an enlarged uterus was one of the most prevalent sonographic findings in patients with molar pregnancy, present in over two-thirds of the cases. Its high frequency suggests it is a key clinical feature that can aid in the early identification of gestational trophoblastic disease, particularly in settings where molar pregnancy is suspected. 32

  46. Table 5.5 of Bunch of Moles Bunch of Moles Frequency Percent Absent 20 64.5 Present 11 35.5 Total 31 100.0 Among the 31 patients evaluated: 35.5% (n = 11) demonstrated the presence of a “bunch of moles” appearance on ultrasound. 64.5% (n = 20) did not exhibit this feature. This finding was less commonly observed, appearing in just over one-third of the cases. While traditionally associated with molar pregnancy, the relatively lower frequency in this sample suggests that the “bunch of moles” appearance may be more specific than sensitive, reinforcing the need to consider it in conjunction with other clinical and sonographic indicators for accurate diagnosis. 33

  47. Table 5.6 of Snowstorm Pattern Snowstorm Pattern Frequency Percent Absent 18 58.1 Present 13 41.9 Total 31 100.0 Out of the 31 cases reviewed: 41.9% (n = 13) showed the presence of a snowstorm pattern on ultrasound. 58.1% (n = 18) did not exhibit this feature. The snowstorm pattern, often considered a hallmark of molar pregnancy due to its distinctive appearance, was identified in less than half of the cases in this study. This suggests that while the snowstorm pattern is a specific indicator, it may not be present in all cases particularly in early gestation highlighting the importance of evaluating a combination of clinical signs and sonographic findings for a more comprehensive diagnosis. 34

  48. Table 5.7 of Vaginal Bleeding Vaginal Bleeding (With or Without) Frequency Percent Absent 11 35.5 Present 20 64.5 Total 31 100.0 Among the 31 patients studied: 64.5% (n = 20) reported vaginal bleeding. 35.5% (n = 11) did not report this symptom. Vaginal bleeding was the most commonly reported clinical symptom, observed in nearly two-thirds of the cases. This finding aligns with existing literature, which identifies vaginal bleeding as a hallmark early symptom of molar pregnancy. Its frequent occurrence reinforces its diagnostic importance and supports its use as a clinical red flag in early pregnancy assessments. 35

  49. Table 5.8 of Lower Abdominal Pain Lower abdominal pain Frequency Percent Absent 9 29.0 present 22 71.0 Total 31 100.0 Out of the 31 patients evaluated: 71.0% (n = 22) reported experiencing lower abdominal pain. 29.0% (n = 9) did not report this symptom. Lower abdominal pain was a highly prevalent clinical feature, present in over 70% of the patients. Its high frequency indicates that it may serve as an important clinical symptom in the early detection and suspicion of molar pregnancy, especially when presented alongside other symptoms such as vaginal bleeding. 36

  50. Table 5.9 of Types of Molar Pregnancy Types of molar pregnancy Frequency Percent Complete Mole 7 22.6 Partial Mole 24 77.4 Total 31 100.0 Out of 31 molar pregnancy cases, 22.6% are complete moles and 77.4% are partial moles. Complete moles involve abnormal tissue without a fetus, while partial moles have some fetal tissue but are still abnormal. Partial moles are more common in this dataset. 37

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