Molar Pregnancy: Types, Risk Factors, Symptoms, Treatment, Complications

Molar pregnancy is an abnormal pregnancy, which results from a genetic error during fertilization leading to the abnormal growth of tissues inside the uterus. Molar pregnancies occur 1 out of every 1000 pregnancies and are called as gestational trophoblastic diseases or hydatidiform mole. Molar pregnancy is characterized by the appearance of grape like clusters in the uterus.

The molar pregnancy can be complete or partial.

The complete molar pregnancy occurs when the sperm fertilizes an empty egg and contains only the placental parts. The placenta produces pregnancy hormone HCG and the ultrasound shows no fetus. The complete molar pregnancy has the genetic material from the father and is duplicated, and no genetic material from the mother (either lost or inactivated).

The partial molar pregnancy contains both the abnormal cells and severe birth defect embryo. In this situation, the mother’s chromosome remains and the father provides two sets of chromosomes resulting in 69 chromosomes for the embryo.

Some of the factors, which increase the risk of molar pregnancy are:

• White women are more at risk than black women for molar pregnancy.
• Women >40 years of age are at an increased risk for molar pregnancy.
• Prior history of molar pregnancy increases the risk of having molar pregnancy in the future too.
• Prior history of miscarriage also increases the risk of having molar pregnancy.

Some of the common symptoms seen in molar pregnancy are: vaginal spotting; nausea; vomiting; thyroid disease; early preeclampsia; increased HCG levels, no fetal movements; absence of fetal heart rate; vaginal passage of grape like cysts; pelvic pressure or pain; rapid uterine growth; ovarian cysts; dark brown to bright red vaginal bleeding in first trimester and anemia.

The diagnosis of molar pregnancy can be done by:

Pelvic Examination: Pelvic examination reveals large or small uterus with enlarged ovaries.

Blood Test: Blood test done in molar pregnancy reveals high levels of HCG.

Ultrasound: The ultrasound shows the characteristic cluster of grapes appearance of molar pregnancy, suggesting abnormal growth of placenta.

Dilation & Curettage: The molar pregnancy usually results in miscarriage where the grape like clusters is expelled. The molar pregnancy is terminated or removed by dilation and curettage by under general anesthesia and done by an OB/GYN doctor.

Chemotherapy & Surgery: The persistent gestational trophoblastic neoplasia of molar pregnancy is treated with either chemotherapy or hysterectomy. The choriocarcinoma developed as a complication from GTN is treated with multiple cancer drugs.

Persistent Molar Tissue: The molar tissue may remain in the uterus and lead to persistent gestational trophoblastic neoplasia even after removal. This may occur either with partial or complete molar pregnancy.

Spreading of Cancerous Tissue: The cancerous form of GTN can lead to choriocarcinoma and spread to other organs. This is mostly seen with complete molar pregnancy than the partial molar pregnancy.

• Inform the doctor in the medical history of any previous molar pregnancy.
• The patient is advised to wait for 6 months to 1 year after a molar pregnancy before trying to conceive again.
• Monitoring of HCG levels monthly for about 6 months to 1 year is recommended to prevent molar pregnancy.
• Genetic counseling is advised before conceiving again after a molar pregnancy.

There are chances of the patient experiencing depression due to molar pregnancy as the dreams, hopes, plans of having a baby are shattered. The sufficient healing time for the mother who has suffered from molar pregnancy is around 6 months to 1 year and this period of time is advised for the patient before conceiving again. Support groups and counseling may be beneficial in recovery for the patient who has had a molar pregnancy.

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