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.