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Molar Pregnancy- Symptoms, Diagnosis And Treatment

4 min read

Molar Pregnancy
Your wait for the grand adventure of motherhood is a really challenging time because this experience will change you mentally and physically forever. One of the most unfortunate and grieving complications during pregnancy is the loss of the baby within the womb. Although rare, molar pregnancy is one such issue about which most of us are unaware. This disease tricks your body of being pregnant wherein actually you may not be, or will eventually lose the baby.

What is Molar Pregnancy

Molar pregnancy (hydatidiform mole) is also known as gestational trophoblastic disease (GTD) – gestational = pregnancy, trophoblastic = placenta related. Placenta is the tissue which is essential for the growth of the baby and is not present in women who are not pregnant. Molar pregnancy is basically a fertilization error which leads to chromosomal mix up. This leads to the abnormal cell growth in placenta and forms fluid filled clusters/sacs in the womb. These obstruct the development of baby.

Types of Molar Pregnancy

Molar pregnancy can either be

  1. Complete: All the symptoms of pregnancy exist and the blood test confirms the hCG (hormone human chorionic gonadotropin) levels which is produced during pregnancy. However the ultrasound scan will not show the fetus, rather parts of placenta. This happens when a sperm fertilizes an empty egg, one that has no genetic information and hence there is no baby. The placenta grows and leads to the formation of hCG in the body. The abnormal tissue forms a lump and grows into the uterus
  2. Partial: Herein, the ultrasound scan may show fetus but this fetal tissue is abnormal and will not develop into a baby. This happens when two sperms fertilize an egg – this leads to overdose of chromosomes for the embryo. This causes rapid abnormal growth in the placenta which quickly consumes the embryo

Sometimes the abnormal growth of cells in placenta can spread to other organs. If not treated timely, these may become cancerous. Although very rare, sometimes a seemingly twin pregnancy can be one fetus and one molar pregnancy. Therefore it is advised and preferred to continuously monitor the pregnancy and watch out for the symptoms of a molar pregnancy.

Symptoms of Molar Pregnancy

Molar pregnancy exhibits the usual symptoms of pregnancy such as missed periods and morning sickness along with :

  • Heavy vaginal bleeding: usually between 6-12 weeks of pregnancy
  • Passing blood clots
  • Watery reddish/brownish discharge which may be continuous or intermittent
  • Passing pieces of molar tissue from the vagina, which appears like bunch of grapes
  • Severe nausea and vomiting
  • Abdominal cramping
  • Early abdominal swelling: unusually bigger abdomen
  • Smaller abdomen: smaller abdomen as compared to that expected during the respective stage of pregnancy
  • Hyperthyroidism: Increased production of hormones by thyroid
  • Hyperemesis: frequent and severe feeling of being sick
  • High hCG levels: higher hCG levels than in normal pregnancy
  • Preeclampsia: high blood pressure and protein (detected in urine) are common in last 3 months of pregnancy but in molar pregnancy this occurs early
  • Anaemia: losing too much blood from vagina can lead to fatigue and feeling unwell
  • No foetal movement or heart rate detection

Sad couple

Causes of Molar Pregnancy
  • Ethnicity:Asian women are at an increased risk of developing molar pregnancy. 1 in every 390 pregnancies in Asian women is molar pregnancy
  • Age:Women in teens or above 40 years are more prone to molar pregnancy
  • Previous history:Women who have had 2 or more miscarriages are more likely to develop molar pregnancy
  • Low carotene diet:Deficiency of carotene which is found in Vitamin A may lead to molar pregnancy
  • Birth control pill:Oral contraceptive may cause molar pregnancy
Diagnosis of Molar Pregnancy
  1. Ultrasound scan:
    • Appearance of placenta: Evidence of fluid filled sacs present in clusters – abnormal growth
    • Uterus: enlarged or smaller than that expected during the respective stage of pregnancy
    • Ovaries: enlarged or smaller than the expected size
  2. Blood test:
    • hCG level: higher than that observed during normal pregnancy
    • Protein: higher than normal serum level
  3. Lab tests: The abnormal tissues are sent to the laboratory to identify molar pregnancy
  4. Placenta check up: The obstetrician may observe the placenta under microscope to check for any abnormal growths
Treatment of Molar Pregnancy

A molar pregnancy can have serious complications; hence it is imperative to get it treated right away. Though most of them are non-cancerous tumour (benign), yet a few cases of cancerous tumour have also come to be seen. Molar pregnancy is treated as follows:

  1. Dilation and curettage: The abnormal tissue in the womb has to be removed surgically. In this procedure, the cervix is widened and the tissue is removed with a gentle suction. An instrument called curette is then used to scrape out any remaining molar tissues from the uterus wall
  2. Medical evacuation: In case of partial molar pregnancy, the doctor may give medicine in the form of tablets to swallow, gel, or a pessary to insert into the vagina. These contract the uterus and help emptying the tissues
  3. Chemotherapy: Sometimes after dilation and curettage procedure, the abnormal cells may remain and spread to other parts of the body. This condition may be identified with increased hCG levels even after 8 weeks of the procedure. Methotrextate – very mild and effective chemotherapy is performed which successfully removes the remaining abnormal cells
  4. Hysterectomy: i.e. removal of the womb, is very rarely performed. However, in cases, where a woman does not want any more children or has persistent heavy bleeding and fibroids
Do’s and don’ts after Molar Pregnancy Surgery
  • Birth control pill is not recommended as they disturb hormones
  • Intra-uterine device is prohibited
  • Refrain from becoming pregnant for one year after chemotherapy
  • Avoid conceiving till the hCG level drops to zero
  • Other contraceptives such as condoms and diaphragms may be used
  • A strict and religious follow-up consisting of routine blood (hCG level)/urine (protein serum) is strongly advised
  • Genetic counselling is recommended for next pregnancy

It is obvious to be depressed and confused with the loss of baby. You and your partner should speak with the doctor and alert him with any of the above symptoms. Fortunately, this condition can be successfully treated and you may enjoy a healthy pregnancy soon after!

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