For most women, pregnancy is a joyous journey filled with anticipation. However, a small percentage experience complications that can be devastating. Molar pregnancy, though rare, is a serious condition that requires prompt diagnosis and management. It is a rare complication that occurs when a fertilised egg doesn't develop normally. Instead of a healthy embryo and placenta, abnormal tissue forms inside the uterus. We spoke to our expert Dr Rajeev Agarwal, IVF Specialist and Medical Director, Renew Healthcare, Kolkata, who explained molar pregnancy, its symptoms, causes, diagnosis, and treatment.
What Is A Molar Pregnancy?
“A molar pregnancy, also known as a hydatidiform mole, is the non-cancerous form of the Gestational Trophoblastic Disorder (GTD) spectrum. For every 714 pregnancies with live births, one develops into a molar pregnancy. Hydatidiform moles occur due to abnormal proliferation of trophoblasts and are of two subtypes - complete and partial, based on genetic and biopsy features”, highlighted Dr Agarwal.
What Is A Complete Mole?
“In a normal pregnancy, an egg is fertilised by one sperm, leading to the development of an embryo and placenta, which nourishes the growing embryo. In complete molar pregnancy, a sperm fertilises an empty egg, hence no embryo is formed. This tumour looks like tiny water-filled sacs mimicking a cluster of grapes”, said Dr Agarwal.
He added, “The unhealthy placenta thus formed contains fluid-filled cysts or tumours that produce the pregnancy hormone called Human Chorionic Gonadotropin (hCG). This hormone is secreted by a healthy placenta in pregnancy, which makes you feel pregnant and gives you a positive pregnancy test.”
Also Read: First Trimester Of Pregnancy: Expert Explains Transformations To Expect During This Phase
What Is A Partial Mole?
“A partial mole occurs when two sperm fertilise one egg. As a result, an abnormal placenta is formed along with a growing embryo with an extra set of chromosomes. This embryo with 69 chromosomes eventually does not survive”, highlighted Dr Agarwal.
Risk Factors For Molar Pregnancy
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- Extremes of age like below 20 years and above 40 years
- Previous two or more miscarriages
- History of molar pregnancy
- Asian population
According to a 2023 study, there is speculation that environmental elements, such as inadequate nutrition and high-altitude exposure may contribute to the onset of molar pregnancy, although further investigation is necessary to establish definitive findings.
Symptoms Of Molar Pregnancy
Molar pregnancies often mimic symptoms of a normal pregnancy initially, including missed periods with positive pregnancy tests, nausea or vomiting and breast tenderness. However, some red flags may emerge:
- Vaginal bleeding is the most common symptom (60%) and can range from light spotting to heavy bleeding, and often occurs in the first three months of pregnancy.
- Severe nausea and vomiting
- The uterus size is usually larger than that expected for the age of the pregnancy.
- Grape-like cysts may come out of your vagina
- Other less common symptoms are overactive thyroid, early onset of extremely high blood pressure and abdominal swelling. Rarely you may cough blood or have seizures.
You should consult your gynaecologists immediately if you experience any of these symptoms.
How To Diagnose A Molar Pregnancy?
The definite diagnosis of molar pregnancy is sometimes difficult and usually involves a combination of a pelvic examination, ultrasound scan and blood investigations to measure pregnancy hormones like hCG.
- An ultrasound of your uterus often shows fluid-filled cysts instead of a placenta or an embryo.
- A blood test can show extremely high levels of the pregnancy hormone, HCG, which suggests a molar pregnancy.
However, the definitive diagnosis is based on a biopsy of the molar tissue retrieved from your uterus.
Treatment and Follow-Up
“Molar pregnancies cannot lead to healthy babies and require removal from your body. This is typically done through a surgical procedure called Dilatation and Evacuation (D&E), which is the procedure of choice for the removal of complete molar pregnancy”, said Dr Agarwal.
Ultrasound guidance during the suction curettage procedure can prevent perforation of the uterus as well as ensure maximal removal of molar tissue. Also, general anaesthesia is given so that you don't feel pain during the surgery.
Dr Agarwal added, “In all cases of molar pregnancy, urgent treatment should be done to prevent complications. In case your blood group is Rhesus D negative, ask your doctor for anti-D immunoglobulin prophylaxis. Following the procedure, close monitoring of serum hCG levels is crucial to ensure the abnormal cells have been removed completely.”
How To Follow Up On A Molar Pregnancy Following Treatment?
“For complete moles, if blood hCG levels normalise within 56 days, then follow-up is for six months post-removal of molar tissue. However, if hCG levels take more than 56 days to normalise, then follow-up is for six months post the date of normalisation”, said Dr Agarwal.
Follow-up in partial pregnancy is completed once the beta hCG levels become normal on two blood samples four weeks apart.
Sometimes, when the hCG levels fail to normalise, additional medication or chemotherapy needs to be given to the patient if indicating a persistent GTD or Gestational Trophoblastic Neoplasia (GTN).
Coping with a Molar Pregnancy
A molar pregnancy can be emotionally and physically challenging. There is nothing worse than a miscarriage of any kind, and a miscarriage during a molar pregnancy is even more challenging. In case you are diagnosed with molar pregnancy, don't hesitate to seek support from your partner, family, friends, or a therapist.
The Future
Dr Agarwal said, “The silver lining is that the vast majority of women who experience a molar pregnancy go on to have successful pregnancies in the future. Your doctor will advise you on the recommended waiting time before attempting to conceive again, which is typically six months to a year.”
Bottomline
Dr Agarwal concluded, “Molar pregnancies, while serious, are treatable. Molar pregnancies result from genetic problems that occur during conception that are beyond your control. Early diagnosis, proper management and adequate follow-up are key to prevent complications. If you have any concerns or are fearful about future pregnancies, please don't hesitate to discuss them with your gynaecologist. Most women go on to have a healthy pregnancy in future.”
[Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your expert if you notice any complications during pregnancy to get the necessary treatment.]