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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Hydatidiform Mole


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
630 - Hydatidiform Mole

Related Terms

  • Choriocarcinoma
  • Gestational Trophoblastic Disease
  • Gestational Trophoblastic Neoplasia
  • GTN
  • Hydatid Mole
  • Molar Pregnancy

Overview

Image Description:
Hydatidiform Mole - An outline of the female abdomen reveals the uterus with left and right ovaries. A close-up of the uterus shows the fallopian tubes on either side, each connecting to an ovary; the vaginal opening into the uterus is at the bottom. The uterus contains a shapeless mass of small blister-like sacs forming a molar pregnancy.
Click to see Image

Hydatidiform mole is an overgrowth of placental tissue or an abnormal growth that develops from a non-viable, fertilized egg at the beginning of a pregnancy. It often is referred to as a molar pregnancy. Instead of the normal embryonic cell division that results in the development of a fetus, the placental material grows uncontrolled and develops into a shapeless mass of watery, small, blister-like sacs (vesicles). The cause of hydatidiform mole is unknown, but is thought to be caused in part by chromosomal abnormalities (Mott).

There are two types of hydatidiform mole: complete and partial (incomplete). A complete hydatidiform mole is the fertilization of an "empty" egg, which results in the overgrowth of placental tissue, but which contains no fetus. With a partial mole, an embryo or fetus (the term used after the eighth week of pregnancy) partially develops but usually does not survive. In this case, the fetus may be identifiable on ultrasound, but fetal heart tones will be absent. Rarely, a hydatidiform mole can develop alongside a fetus, and although the birth of a normal infant is possible, the pregnancy is considered high-risk and may result in significant harm to the mother if completed (Moore). Hydatidiform mole also can develop after a spontaneous abortion (miscarriage) or after a full-term pregnancy from cells remaining in the uterus.

Incidence and Prevalence: The exact number of pregnancies that result in hydatidiform mole is unknown, as in many cases they result in miscarriage. The estimated number is 1 of every 1,000 to 2,000 pregnancies (Mott).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Women older than 35 are at twice the risk for hydatidiform mole, and those over age 40 are 5 to 10 times more likely to develop the condition (Moore). Risk factors also include a maternal age under 16 years (Vorvick). Poor nutrition, especially low intake of vitamin A precursor (carotene) and a diet low in protein and animal fat, may be an additional risk factor.

Source: Medical Disability Advisor



Diagnosis

History: The most common symptom of hydatidiform mole is vaginal bleeding, which occurs in up to 50% of cases (Moore). Sometimes tissue containing grapelike vesicles passes through the vagina during the first 3 months of pregnancy. Women also may report abdominal or pelvic pressure or pain, excessive nausea and vomiting (hyperemesis gravidarum), fatigue, shortness of breath, coughing, or abdominal swelling that resembles an exaggerated pregnancy. Rarely, women report a rapid heartbeat or a feeling of tremulousness or warmth.

Physical exam: The most common sign of a hydatidiform mole on physical exam is a uterus that is unusually large (50% of cases), or too small (33% of cases) for gestational dates (Vorvick). There generally are no fetal heart tones or fetal movement. Toxemia of pregnancy (preeclampsia-like symptoms and signs) may develop during the first 24 weeks of pregnancy; blood pressure may be elevated.

Tests: Blood tests may be performed to measure complete blood count (CBC), clotting tests, thyroid function, serum inhibin levels, liver and kidney function, and the level of human chorionic gonadotropin (hCG), which is normally produced early in pregnancy. An ultrasound scan of the pelvis may be performed to ensure that the growth is a molar pregnancy and not a fetus. If a molar pregnancy is diagnosed, x-rays, magnetic resonance imaging (MRI), or computed tomography (CT) of the chest, pelvis, brain, or abdomen may be done to see if the mole has spread outside the uterus.

Source: Medical Disability Advisor



Treatment

Some hydatidiform moles disappear spontaneously (spontaneous miscarriage). The most common treatment for those that do not is a procedure in which the uterine lining is scraped away (suction dilation and curettage [D&C]). Removal of the uterus (hysterectomy) is an option if the woman does not intend to become pregnant again. If further pregnancies are planned and the mole is advanced, a procedure in which an incision is made through the abdomen into the uterus (abdominal hysterotomy) may be necessary to remove the mole. Blood transfusion may be needed in cases with severe anemia. Chemotherapy or radiation is occasionally used for more aggressive moles that have become malignant (choriocarcinoma).

Because of the risk of invasive moles and choriocarcinoma, the hCG level is monitored after molar pregnancy. Initially, monitoring is weekly. The hCG level generally drops to normal within 8 to 12 weeks following evacuation of the mole (Moore). Once the levels are consistently within normal range for 3 to 4 weeks, monitoring is then conducted monthly for 6 months (Moore). Because growth may recur, a woman should not become pregnant during the follow-up period; effective contraception is needed. If a choriocarcinoma has developed, the tumor is removed immediately and hCG levels measured accordingly. Chemotherapy may be used in women with a choriocarcinoma or after evacuation if the hCG level does not return to normal or increases.

Source: Medical Disability Advisor



Prognosis

Prognosis for treated individuals is excellent. Mortality from hydatidiform mole that has not spread is almost zero with early diagnosis and appropriate treatment (Moore). After D&C, 84% of complete and 99.5% of partial hydatidiform moles are cured (Mott). Complete moles may progress to malignancy even after evacuation in 15% to 20% of cases (Moore), and after hysterectomy, 3% to 5% become malignant (Mott). Partial moles progress to malignancy in 2% to 3% of cases (Mott). The cure rate is 60% to 80% in women with choriocarcinoma that has spread widely (Gershenson).

It is usually possible for women to have a normal, healthy pregnancy after treatment for hydatidiform mole, but ultrasonography should be performed early during future pregnancies. After 1 hydatidiform mole, the risk of recurrence is 1.2% to 1.4%; after the second mole, the risk increases to 20% (Moore).

Source: Medical Disability Advisor



Differential Diagnosis

  • Dysfunctional uterine bleeding
  • Excess fluid within the placenta (hydramnios)
  • Hyperemesis gravidarum
  • Intrauterine fetal death
  • Normal pregnancy with incorrect dates
  • Ovarian tumor
  • Pregnancy with twins
  • Trophoblastic tumor (choriocarcinoma, chorioadenoma)
  • Uterine fibroid

Source: Medical Disability Advisor



Specialists

  • Gynecologist
  • Obstetrician/Gynecologist
  • Oncologist

Source: Medical Disability Advisor



Complications

Complications can include anemia from chronic blood loss, toxemia of pregnancy, hyperthyroidism, heart failure, release of the trophoblast into the bloodstream (trophoblastic embolization), hemorrhage, and overwhelming infection (sepsis). Trophoblastic embolization may result in severe respiratory problems (acute pulmonary insufficiency).

In up to 20% of cases, moles extend into the uterine wall and are considered invasive (Moore). Although invasive moles are aggressive and can spread, they are not cancerous. They may rupture the wall of the uterus, resulting in hemorrhage and the spreading of molar tissue to distant organs.

Other complications include the development of choriocarcinoma. This highly aggressive cancer occurs in 15% to 20% of complete moles (Moore) and in 2% to 3% of partial moles (Mott). Cancer may spread rapidly to the lungs, lower genital tract, brain, liver, kidney, and gastrointestinal tract via the bloodstream or lymphatic vessels.

Source: Medical Disability Advisor



Factors Influencing Duration

Duration depend on the type of treatment performed. Women undergoing hysterectomy or abdominal hysterotomy may require longer recovery times, and chemotherapy may also prolong the recovery period.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

If a surgical procedure is performed (suction dilation and curettage, hysterectomy, abdominal hysterotomy), heavy lifting or work requiring long periods of standing may need to be modified during the recovery period. Time off from work may be needed for doctor appointments and therapeutic procedures. In addition, time off from work may be needed for grieving. Additional time off from work may be needed if chemotherapy is given. Specific restrictions must be individualized based on circumstances of presentation.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Is individual under age 16 or over age 40?
  • Does individual have a history of hydatidiform mole or of miscarriages?
  • Did individual report abnormal bleeding from the uterus and passage of grapelike vesicles during the first 3 months of pregnancy?
  • Did individual report abdominal or pelvic pressure or pain, and excessive nausea and vomiting (hyperemesis gravidarum)?
  • Was blood pressure elevated?
  • Was uterus unusually large or too small for gestational dates?
  • Did individual exhibit symptoms and signs of toxemia of pregnancy in the first 24 weeks of pregnancy?
  • Were blood and urine tested for excessive amounts of hCG?
  • Was the diagnosis of hydatidiform mole confirmed? Ultrasound performed?
  • Was x-ray, MRI, or CT scan needed to check for spread of mole outside of uterus?

Regarding treatment:

  • Was the pregnancy terminated?
  • Were the contents of the uterus removed with D&C or, if no further pregnancies were planned, was the uterus removed (hysterectomy)?
  • Did any complications occur as a result of either of these procedures?
  • If individual plans further pregnancies, was abdominal hysterotomy required to remove the hydatidiform mole?
  • Did hCG levels return to normal after evacuation?
  • Was contraception used to prevent pregnancy during the follow-up period?

Regarding prognosis:

  • Was the hydatidiform mole treated, or did it disappear spontaneously?
  • After evacuation, were hCG levels monitored regularly to detect possible progression to malignancy?
  • If mole was invasive, did rupture of the uterine wall and hemorrhage occur? If so, how severe was blood loss? Was blood transfusion required?
  • Did invasive mole spread to other organs?
  • Has individual developed choriocarcinoma?
  • If so, was the tumor removed completely? Was chemotherapy given?
  • Has individual experienced other complications, such as anemia, hyperthyroidism, heart failure, trophoblastic embolization, or sepsis?
  • How were any complications treated? What is the expected outcome with treatment?
  • Does individual plan to become pregnant in the future?

Source: Medical Disability Advisor



References

Cited

Gershenson, Davi M., and Pedro T. Ramirez. "Hydatidiform Mole." The Merck Manual Home Edition. Merck and Company, Inc., 2008. Merck Manuals Online. Nov. 2009. Merck & Co., Inc. 3 Nov. 2009 <http://www.merck.com/mmhe/sec22/ch252/ch252h.html>.

Moore, Lisa E., and Enrique Hernandez. "Hydatidiform Mole." eMedicine. Eds. Jordan G. Pritzker, et al. 24 Sep. 2008. Medscape. 2 Nov. 2009 <http://emedicine.medscape.com/article/254657-overview>.

Mott, Daniel D., and Eric E. Sauerbrei. "Hydatidiform Mole." eMedicine. Eds. Christopher L. Sistrom, et al. 19 Jan. 2007. Medscape. 2 Nov. 2009 <http://emedicine.medscape.com/article/405778-overview>.

Vorvick, Linda, and Susan Storck. "Hydatidiform Mole." MedlinePlus. 28 Oct. 2009. National Library of Medicine. 3 Nov. 2009 <http://www.nlm.nih.gov/medlineplus/ency/article/000909.htm>.

Source: Medical Disability Advisor