Molar Pregnancy

1 What is Molar Pregnancy?

Molar pregnancy or hydatidiform mole is a non cancerous or benign tumor that develops in the uterus and starts with a fertilized egg and that the placenta develops into an abnormal mass of cysts.

There is no placenta tissue or embryo in a complete molar pregnancy while in a partial molar pregnancy there is an abnormal embryo and normal placenta tissue.

At first the embryo is developing but then it’s malformed and can’t survive. Serious complications such as a rare form of cancer are a result of molar pregnancy and require early treatment.

2 Symptoms

It may seem normal at first but molar pregnancies have signs and symptoms such as:

  • severe nausea and vomiting,
  • dark brown to bright red vaginal bleeding during the first trimester,
  • pelvis pressure,
  • vaginal passage of grape like cysts,
  • rapid uterine growth when the uterus is too large for the stage of pregnancy,
  • preeclampsia when there is high blood pressure and protein in the uterine after 20 weeks of pregnancy,
  • high blood pressure,
  • ovarian cysts,
  • overactive thyroid or hyperthyroidism.
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3 Causes

An abnormally fertilized egg is the cause of molar pregnancy.

Human cells can contain 23 pairs of chromosomes and one chromosome in each pair comes from the mother and the other is from the father. The chromosomes form the mother’s eggs are lost or inactivated after fertilization and chromosomes of the father are duplicated and the egg may have no nucleus or had an inactive nucleus.

The chromosomes of the mother remains but the father provides two sets of chromosomes in an incomplete or partial molar pregnancy resulting to having 69 chromosomes instead of 46 that can happen when two sperm fertilize a single egg or the chromosomes of the father are duplicated.

4 Making a Diagnosis

Making a diagnosis of molar pregnancy is done by performing several tests.

Visit your doctor if you are concern about your health.

Know about what to expect from your doctor.

Here are some of the things that you might need to do:

  • Bring a notebook so that you can list all the things that you want to ask the doctor or things that he will tell you.
  • Write down the symptoms that you are experiencing and the medications, supplements or vitamins that you are taking every day.
  • Write down the last menstrual period.
  • You can also list down the medical conditions that you had and your family history.
  • You may bring a family member or a close friend in order for them to help you with relevant information and to support you.

If you want, you can also prepare a list of questions to your doctor. Some of the questions may include:

  • What is causing my symptoms?
  • What do I need to do now?
  • What tests I need to take?
  • Are there any treatments?
  • Do I have any restrictions including my lifestyle?
  • What signs and symptoms should I watch for at home?
  • What are the chances for successful pregnancy?
  • How long should I wait to become pregnant again?
  • Will this increase my risk for cancer?
  • What websites do you recommend?

Your doctor will likely ask you questions. These questions include:

  • When was your last menstrual?
  • When did you first experience the symptoms?
  • Are they continuous or occasional?
  • Do you feel any pain?
  • Are you bleeding more or less compared with your heaviest days of menstrual flow?
  • Are there any grape-like cysts that passed your vagina?
  • Are you dizzy?
  • Do you have any chronic conditions? If so, what is it?
  • Are you still planning to become pregnant in the future?
  • Have you had a past molar pregnancy?

Your doctor may perform physical exam as well as a blood test to measure the level of human chorionic gonadotropin or HCG in your blood which is a pregnancy hormone and ultrasound, high frequency sound waves are directed at the tissue in the pelvic and abdominal area.

An ultrasound may be done through a wand-like device that is placed in your vagina because the uterus and fallopian tubes are closer to the vagina to the abdominal surface during early pregnancy.

As early as eight or nine weeks of pregnancy, an ultrasound of complete molar pregnancy may be detected and may show:

  • no amniotic fluid;
  • no fetus or embryo;
  • ovarian cysts and a thick cystic placenta nearly filling the uterus.

A partial molar pregnancy when done by ultrasound may show:

  • low amniotic fluid;
  • growth-restricted fetus;
  • thick cystic placenta.

Your doctor may check for other medical problems such as:

5 Treatment

The molar tissue must be removed to prevent complications of molar pregnancy and these treatments are:

  • Dilation and curettage or D&C: in this procedure of the doctor will remove the molar tissue from your uterus and can be done as an outpatient, you’ll receive a general or local anesthetic and lie on your back with your legs in stirrups then your doctor will insert a spectrum inside your vagina to see your cervix that will be dilated and will remove the uterine tissue and this usually takes 15 – 30 minutes;
  • Hysterectomy, which is a surgery to remove your uterus if the molar tissue is extensive and there is no desire for future pregnancies;
  • HCG monitoring, your doctor will monitor your HCG level until it returns to normal after the tissue is removed, but you may need additional treatment if you continue to have HCG in your blood, after it is complete it will be monitored by your doctor for six months to one year.

If you want to become pregnant again, your doctor may suggest waiting until after the follow-up.

6 Prevention

If you've had a molar pregnancy, talk to your doctor before conceiving again, because he/she may recommend waiting for six months to one year to prevent any complications.

Your family doctor may do early ultrasounds to monitor your condition and to reassure you that there will be a normal development.

7 Alternative and Homeopathic Remedies

For women who may have a tendency to miscarriage or have a molar pregnancy, these homeopathic remedies may help but under a certified homeopath:

  • Caulophyllum,
  • Sabina,
  • Viburnum opulus,  
  • Cimicifuga,
  • Secale,
  • Sepia. 

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with molar pregnancy.

Give yourself and your husband time to grief because pregnancy loss is so devastating.

You can ask support from your husband, partner, family and friends and talk about what you are feeling and your emotions.

You can also ask a counselor or seek advice from a support group.

9 Risks and Complications

1 in every 1,000 pregnancies is molar and the risk factors associated with molar pregnancy includes:

  • maternal age, most likely to occur in women who are over 35 years of age than women who are younger than 20 years old;
  • previous molar pregnancy, you are more likely to have another one if you had one in the past, this happens to 1 to 2 out of every 100 women because after a molar pregnancy has been removed molar tissue may remain and continue to grow which is called persistent gestational trophoblastic disease or GTD. It can occur to 1 to 5 women after a complete mole rather than a partial one. When the level of HCG which is a pregnancy hormone remains high after the molar pregnancy has been removed is a sign of persistent GTD. This can be treated with chemotherapy. In some cases there is vaginal bleeding if an invasive mole penetrates deep into the middle layer of the uterine wall. The removal of uterus is another treatment. Choriocarcinoma that is a rare cancerous form of GTD develops and spreads to other organs but multiple cancer drugs can treat this disease.
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