What Is Molar Pregnancy, And How Can You Recognize It?

A molar pregnancy or hydatidiform mole is an abnormal pregnancy which results from abnormal fertilization. As a consequence, the tissue that should normally form the placenta and fetus inside the uterus forms an abnormal mass of cysts. This grape-like cystic mass is called a “mole”. This is not a viable pregnancy; it does not result in a living fetus.

Molar pregnancy itself is not physically dangerous but if left untreated, it can result in some serious complications including cancer. Molar pregnancy is actually a precancerous condition. If this tissue remains in the uterus for a long time, it may develop into a cancer called choriocarcinoma.

Types Of Molar Pregnancy

Hydatidiform moles can be divided into two types: a complete mole and an incomplete mole.

• When two sperm cells fertilize an empty egg (with no genetic material), a complete mole is formed as a result. All the genetic material comes from the father's side. There is no fetal tissue in a complete mole; instead a grape-like mass is formed inside the uterus.
• When a normal egg is fertilized by two sperm cells, a partial or incomplete mole is formed as a result. There are 69 chromosomes in this embryo instead of 46. An incomplete mole has some fetal parts along with an abnormal cystic mass.

Symptoms Of Molar Pregnancy 

In the beginning, a molar pregnancy causes all the typical signs and symptoms of a normal pregnancy like a missed period, morning sickness and a positive pregnancy test. The beta hCG levels are raised and uterus also increases in size. After a few weeks, a molar pregnancy causes the following signs and symptoms:

• Bleeding from the vagina during the first trimester (bright red to dark brown in color)
• Severe nausea and vomiting
• The uterus will be larger than it should be in a normal pregnancy
• Discomfort, pressure or pain in the pelvic region
• Sometimes the grape-like cysts of the mole are passed out through the vagina
• Symptoms of hyperthyroidism like fatigue, sweating, irregular heart beat and nervousness
• High blood pressure can also develop in some women

Some of these symptoms are also present in a normal pregnancy and therefore the patient may perceive it as a normal pregnancy. If you are experiencing the signs and symptoms of a molar pregnancy contact your obstetrician, who will then look for the signs of a molar pregnancy like a large for date uterus, and then order some tests to confirm the diagnosis.

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Most of the time, molar pregnancy is incidentally diagnosed in the first ultrasound scan of the pregnancy. This scan is usually done at 10-14 weeks in a normal pregnancy. If this scan is not done due to improper facilities or lack of awareness (in less developed regions), a molar pregnancy may go on to cause severe complications. Therefore it should be managed as early as possible.

Diagnosis And Management Of Molar pregnancy

In the early stages, a molar pregnancy is just like a normal pregnancy, so it may get overlooked by the patient. But after a few weeks, the symptoms become severe enough to prompt a visit to the OB/GYN.

How Is A Molar Pregnancy Diagnosed?

When a pregnant woman presents with vaginal bleeding and her uterus is larger than it should be, it leads the doctor towards suspecting a molar pregnancy. The doctor will then order the following tests.

A blood test to measure the levels of beta hCG is ordered right away. Human Chorionic Gonadotropin or beta hCG is the pregnancy hormone that is detected by a urine pregnancy test. In a molar pregnancy its levels in the blood are much higher than they should be in a normal pregnancy because the abnormal molar tissue produces a large amount of beta hCG.

A trans-vaginal ultrasound scan is also done. It confirms the diagnosis because there is no embryo or fetus visible in the scan in case of molar pregnancy. Instead there are grape-like cystic masses visible in the uterus (often called snow storm appearance).

A molar pregnancy is usually confirmed by these two tests. After confirmation, immediate removal of the molar tissue should be the next step, along with proper counseling of the patient.

Emotional Aspects Of A Molar Pregnancy    

A molar pregnancy can never result in a living baby; therefore its removal is necessary. It is important that the mother is properly counseled before the treatment because she is most probably expecting a baby in her hands after a few months. She should be properly informed that it is not a real pregnancy, that it should be terminated, and if this is not done in a timely manner, it can cause severe complications like cancer.

Treatment Options For A Molar Pregnancy

There are two treatment options for a hydatidiform mole. The choice depends on whether the family of the patient is completed or not.

• Dilatation and Curettage (D&C) is a procedure in which the doctor first dilates the cervix of the patient and then the molar tissue is removed via suction. This procedure can be done under local or general anesthesia. It is usually an outpatient procedure and takes about 15 to 30 minutes.
• Hysterectomy. If the family of the patient is completed and the couple does not want any more children, then the uterus is removed along with all the molar tissue in a surgery called hysterectomy. This surgery has lower recurrence rates.

Follow Up

In order to check whether all of the molar tissue is removed or not, beta hCG levels are measured regularly after D&C. If the levels go down it means that the treatment was successful. Beta hCG levels are usually monitored from six months to one year after the treatment of mole. Because a normal pregnancy also increases the beta hCG levels in blood, the doctor may recommend waiting for the next baby until the follow up is completed.

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A molar pregnancy is not a serious condition if detected early, but it may lead to complications if not managed properly. Emotional and psychological support for the mother should also be included in the management.