A molar pregnancy develops from issues that arise during the fertilization of an egg by sperm. A placenta develops throughout a regular pregnancy to feed the developing fetus. Normal placenta development does not occur in molar pregnancies. Most people who undergo therapy go on to become pregnant again in a healthy way.
What Is A Molar Pregnancy?
A molar pregnancy, also known as a hydatidiform mole, is a rare type of pregnancy that occurs when abnormal cells form in the uterus, instead of a fetus. These abnormal cells grow into a mass of cysts that resemble a cluster of grapes, which is where the condition gets its name. Molar pregnancies are a form of gestational trophoblastic disease (GTD), which is a group of rare tumors that can occur during pregnancy.
Molar pregnancies are typically diagnosed during the first trimester of pregnancy through an ultrasound or by detecting high levels of hCG (human chorionic gonadotropin) in the blood.
While molar pregnancies are very rare, with an occurrence rate of about 1 in 1,000 pregnancies, it is important for women to be aware of the signs and symptoms of a molar pregnancy so that they can seek medical attention if they suspect they may have one. Symptoms can include vaginal bleeding, abdominal pain, and nausea.
What Are The Types Of Molar Pregnancy?
There are two types of molar pregnancies: Complete and partial.
Complete Molar Pregnancy
A complete molar pregnancy occurs when the placenta develops into a mass of cysts and there is no normal fetal tissue present. This type of molar pregnancy is caused by the abnormal growth of trophoblastic tissue, which is the tissue that surrounds and nourishes the fertilized egg. In a complete molar pregnancy, the egg is usually not fertilized or is fertilized by two sperms, leading to the formation of an abnormal placenta. Symptoms of a complete molar pregnancy include vaginal bleeding, pelvic pain, and an enlarged uterus.
Partial Molar Pregnancy
A partial molar pregnancy (incomplete molar pregnancy), also known as a partial hydatidiform mole, is a molar pregnancy in which there is an abnormal growth of trophoblastic tissue and some normal fetal tissue is present. This type of molar pregnancy is caused by the fertilization of an egg by one sperm and one empty egg, leading to the formation of an abnormal placenta and a malformed fetus. Symptoms of a partial molar pregnancy may include vaginal bleeding, pelvic pain, and an enlarged uterus. In this type, the fetal tissue can be malformed and may not survive.
What Causes A Molar Pregnancy?
The exact cause of molar pregnancy is not known, but it is thought to be related to abnormal cell division and growth in the placenta. It is important to note that most molar pregnancies occur by chance and are not related to any specific cause.
What Are The Risk Factors For Molar Pregnancy?
Certain factors may increase the risk of a molar pregnancy, but it is not clear why some women develop a molar pregnancy while others do not.
Some of the factors that may increase the risk of a molar pregnancy include:
- Women younger than 15 years.
- Women with advanced maternal age.
- History of molar pregnancy.
- Family history of molar pregnancy.
- Women of Asian origin.
It’s important to note that having one or more of these risk factors does not guarantee that a woman will have a molar pregnancy, and many women who have molar pregnancies have no known risk factors.
Related: What is preeclampsia?
What Are The Signs and Symptoms Of Molar Pregnancy?
The symptoms of a molar pregnancy can vary depending on the type of molar pregnancy and the stage of the pregnancy. However, some common symptoms of a molar pregnancy include:
- Vaginal bleeding or spotting: This is the most common symptom of a molar pregnancy and can occur at any time during the pregnancy. The bleeding may be light or heavy and may be accompanied by cramping.
- Nausea and vomiting: These symptoms may be more severe than typical morning sickness.
- Rapid uterine growth: The uterus may be larger than expected for the stage of the pregnancy.
- Pelvic pain or discomfort: This can be caused by the rapid growth of the uterus and the presence of cysts in the placenta.
- Hyperthyroidism: Molar pregnancies can cause an increase in the production of hCG, a hormone that can cause symptoms of hyperthyroidism such as rapid heartbeat, sweating, and weight loss.
- Anemia due to heavy bleeding
How Is A Molar Pregnancy Diagnosed?
A molar pregnancy is typically diagnosed through a combination of a pelvic exam, ultrasound, and blood tests.
- During a pelvic exam, your doctor will check the size of your uterus and may detect any cysts or masses in the placenta.
- An ultrasound is the most important diagnostic tool for a molar pregnancy. It will allow the doctor to visualize the placenta and the presence of cysts. The ultrasound can also detect if there is any fetal tissue present.
- Blood tests are also used to diagnose a molar pregnancy. The most important test is a human chorionic gonadotropin (hCG) test, which measures the level of hCG in the blood. Molar pregnancies are characterized by high levels of hCG, which are usually much higher than expected for the stage of pregnancy. Other blood tests, such as a complete blood count (CBC), may also be performed to check for anemia or other complications.
- A biopsy of the placenta can also be performed to confirm the diagnosis of a molar pregnancy, but it is not always necessary.
It’s important to note that a molar pregnancy can mimic other types of pregnancy complications, such as an ectopic pregnancy. Therefore, it’s important to seek medical attention right away if you suspect you have a molar pregnancy so that you can be properly diagnosed and treated.
How Soon Can Molar Pregnancy Be Detected?
Molar pregnancy can be detected as early as the first trimester of pregnancy, usually around 6-14 weeks. However, in some cases, it may not be diagnosed until later in the pregnancy.
The most common symptom of a molar pregnancy is vaginal bleeding or spotting, which can occur at any time during the pregnancy. Therefore, it is important for any woman who experiences bleeding or spotting during pregnancy to seek medical attention as soon as possible.
Can A Baby Survive A Molar Pregnancy?
In a complete molar, there is no normal fetal tissue present, therefore a baby cannot survive. In a partial molar, some normal fetal tissue is present, but the fetus is malformed and may not survive. In both cases, the abnormal tissue needs to be removed through a procedure called suction curettage or dilation and curettage (D&C) as soon as possible.
It’s important to note that while a molar pregnancy is not a viable pregnancy, it is a medical emergency that requires prompt attention and care. The abnormal tissue can cause bleeding, pain, and an increased risk of developing a rare type of cancer called gestational trophoblastic disease (GTD).
Related: Is Bleeding During Pregnancy Normal?
How Is The Treatment of Molar Pregnancy?
The treatment for a molar pregnancy typically involves removing the abnormal tissue through a procedure called suction curettage or dilation and curettage (D&C). This procedure is usually done under general anesthesia and involves dilating the cervix and scraping away the abnormal tissue from the uterus. In some cases, a hysterectomy (surgical removal of the uterus) may be necessary, especially in the case of a persistent or recurrent molar pregnancy.
After the procedure, close monitoring of the hormonal levels is needed, as there is a risk of developing a rare type of cancer called gestational trophoblastic disease (GTD). This monitoring typically involves blood tests and follow-up visits to check hCG levels and confirm that they return to normal. If GTD is detected, further treatment may include chemotherapy.
It is important to note that a molar pregnancy can have serious implications on future pregnancies and it is important to discuss with a healthcare professional to understand the risks and benefits. Also, it is important to have a follow-up check-ups and to be in touch with a gynecologist who has experience in molar pregnancies, as early detection and treatment is crucial for the best possible outcome.
It’s important for women who have had a molar pregnancy to inform their healthcare provider in future pregnancies as they are at an increased risk of developing another molar pregnancy or GTD.
Can Folic Acid Prevent Molar Pregnancy?
There is no evidence that taking folic acid can prevent molar pregnancy. The cause of molar pregnancy is not well understood, but it is thought to be related to genetic or chromosomal abnormalities that occur during the formation of the placenta. Folic acid can help prevent certain birth defects in the baby but it does not prevent molar pregnancy.
However, it is still important for women who are planning to become pregnant or who are already pregnant to take folic acid supplements as per their healthcare provider’s recommendations, as well as to follow a healthy diet, exercise and take prenatal care to support a healthy pregnancy.
What Does A Molar Pregnancy Look Like In An Ultrasound?
In an ultrasound, a molar pregnancy typically appears as a mass of cysts that fill the uterus. The cysts are usually small, round, and fluid-filled, and they may have a characteristic “honeycomb” or “cluster of grapes” appearance. The cysts can be of various sizes and may be evenly distributed throughout the uterus or they may be located in one area.
In a complete molar pregnancy, the uterus will be enlarged and filled with cysts, but there will be no visible fetal tissue. The placenta will also be abnormal and may appear as a thickened area on the uterus’s wall.
In a partial molar pregnancy, the uterus will be enlarged and filled with cysts, and there will be some visible fetal tissue. However, the fetus will be malformed and will not develop normally. The placenta will also be abnormal and may appear as a thickened area on the uterus’s wall.
How High Is hCG In Molar Pregnancy?
Human chorionic gonadotropin (hCG) is a hormone that is produced by the placenta during pregnancy. In a normal pregnancy, hCG levels will increase as the pregnancy progresses. However, in a molar pregnancy, hCG levels will be much higher than expected for the stage of the pregnancy.
In a complete molar, hCG levels can be extremely high, often reaching several times the normal level for the stage of pregnancy. In a partial molar pregnancy, hCG levels may be slightly lower than in a complete molar, but still much higher than expected for the stage of pregnancy.
It’s important to note that hCG levels alone are not always reliable for the diagnosis of a molar pregnancy, as they can vary greatly depending on the stage of the pregnancy, the type of molar pregnancy, and the individual woman. Therefore, doctors will use hCG levels in conjunction with other diagnostic tools such as pelvic exams, ultrasound, and blood tests to confirm the diagnosis.
Do All Molar Pregnancies Need Chemo?
Not all molar pregnancies require chemotherapy. The majority of cases of molar pregnancies are diagnosed early, treated with surgery (such as suction curettage or dilation and curettage (D&C)) and the follow-up monitoring of hCG levels is done to confirm that the hCG levels return to normal.
However, in some cases, molar pregnancies can lead to the development of gestational trophoblastic disease (GTD) which is a rare type of cancer that can develop after a molar pregnancy. GTD can occur when some of the abnormal cells remain in the uterus after the initial treatment and can continue to grow, spreading to other parts of the body. If GTD is detected, further treatment may include chemotherapy. The type of treatment depends on the stage of the disease and the woman’s overall health.