Breathing Through the Crisis: Anaesthetic Strategies in Molar Pregnancy with Cardiac and Pulmonary Complications

Abstract

Gestational trophoblastic disease (GTD) represents an unusual complication of pregnancy, often identified as molar pregnancy or hydatidiform mole. GTD is defined by the presence of hydatidiform hydrophilic villi and atypical hyperplastic trophoblast, typically occurring in women of reproductive age. The prevalence of molar pregnancy in Malaysia is 2.6 cases per 1,000 deliveries.2 Molar cells are benign; however, there exists a slight risk of malignant transformation if not completely removed. Molar pregnancies are rare but represent the primary type of gestational trophoblastic disease (GTD). It occurs roughly two times more often in Asian women than in non-Asian women. In severe instances, patients may exhibit complications of molar pregnancy, including cardiorespiratory dysfunction, substantial haemorrhage leading to disseminated intravascular coagulation (DIC), or neurological symptoms such as seizures, which may be linked to metastatic disease. Multiple reports have documented fatalities in postoperative care due to cardiopulmonary distress. The complexities of anaesthetic management include both intraoperative and postoperative care. Present data suggest that severe cases of molar pregnancy with early progression of complications require preoperative intensive care management.