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What Is a Molar Pregnancy?

calendarJuly 26, 2016
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Signs of molar pregnancy

This is a severe abnormality of the placenta. The problem occurs at the moment when the egg and the sperm meet each other for fertilization. A molar pregnancy happens if the egg is fertilized, but then the placenta develops into an abnormal mass of cysts instead of a healthy fetus.

How Often Does It Happen?

1 out of every 1,000 pregnancies happens to be a molar one. This condition is also known as gestational trophoblastic disease (GTD).

What Is the Difference Between Complete Molar Pregnancy and Partial Molar Pregnancy?

In the case of complete molar pregnancy, there is no embryo or normal placental tissue. It occurs when the sperm fertilizes an empty egg. Then, no baby is formed. At the same time, the abnormal placenta will grow and produce the pregnancy hormone, known as hCG.

When it is a partial molar pregnancy, there is an embryo and sometimes - a normal placental tissue. The embryo, however, is not normal and is known as a "mole". It begins to develop but is malformed and unable to survive. There is also an extremely rare version of the partial molar pregnancy. It happens when twins are conceived and one embryo begins to develop normally but the other one is a mole. Unfortunately, the healthy embryo will be destroyed by the abnormal tissue pretty quickly.

A Genetic Explanation of Molar Pregnancies

A molar pregnancy occurs as a result of an abnormally fertilized egg. Normally, human cells contain 23 pairs of chromosomes. In the baby, one chromosome from each pair comes from the father, the other one is from the mother. In the case of a complete molar pregnancy, all of the chromosomes come from the father. Soon after the fertilization has occurred, the chromosomes from the mother egg are get lost or remain inactivated. At the same time, the father's chromosomes are duplicated.

In the case of a partial or incomplete molar pregnancy, there are chromosomes from the mother. The problem is that the father again provides two sets of chromosomes. So, now the embryo has 69 chromosomes instead of 46. This condition occurs when the father's chromosomes are duplicated or when two sperm fertilize one egg.

How Often Does Molar Pregnancy Happen?

A statistics point that in the United States 1 out of 1,000 pregnancies happens to be a molar one. The rate is higher in many Asian countries such as the Philippines. There are other known factors: white women are more endangered than black women; women who have already had a molar pregnancy or a miscarriage are at a higher risk; women over 40, too.

Molar Pregnancy Symptoms

At the beginning, the molar pregnancy may seem like a normal one. Then some of the following symptoms will appear:

  • dark brown to bright red vaginal bleeding in the first trimester;
  • thyroid disease;
  • intensive nausea and vomiting;
  • high blood pressure.

If you notice any of these, consult your doctor immediately. During your examination, the specialist might find other symptoms, such as:

  • lack of fetal movement or heart tone;
  • intensive uterine growth. As a result, the uterus is too large for this stage of pregnancy;
  • preeclampsia — it might be discovered with a urine test. This condition leads to protein in the urine after week 20 of pregnancy;
  • anemia;
  • ovarian cysts;
  • hyperthyroidism.

What Should be Done to Discover Molar Pregnancy?

Regular visits to the doctor are needed during the whole pregnancy. This will help you find out if there is any problem with you or the baby.

If you have any symptoms of a molar pregnancy, a pelvic exam will help the doctor reveal if you have this condition. It will show if you have an enlargement of the ovaries or the uterus. Testing the levels of the pregnancy hormone hCG will be also a sign whether you have a molar pregnancy.

The doctor will also make you a sonogram which often reveals a "cluster of grapes" in the case of a molar pregnancy.

What to Expect from the Visit to the Doctor?

You should expect from your doctor to perform a physical examination and run a few tests. You need to be done a blood test and an ultrasound exam. The doctor will ask you questions connected with the common molar pregnancy causes and symptoms. Be ready to answer the following questions:

  • Are you having pains? In what areas of your body?
  • When was your last menstrual period?
  • Do you have a vaginal bleeding? What is its color?
  • Do you have lightheadedness or dizziness?
  • When did your symptoms appear for the first time? Are they continuous or occasional?
  • Have you passed any grape-like cysts from the vagina?
  • Have you had a past molar pregnancy by far?
  • Do you have any chronic condition?

If there are any reasons for your health care provider to suspect a molar pregnancy, a blood test to measure the levels of HCG has to be done. An ultrasound will also show whether there is a problem.

Molar Pregnancy Ultrasound Examination

The standard ultrasound examination includes directing high-frequency sound waves to the tissues in the abdominal and pelvic area. The ultrasound of a complete molar pregnancy will probably show a lack of embryo or fetus, as well as of amniotic fluid; ovarian cysts; a thick cystic placenta, filling the uterus. These symptoms will appear as early as week 8 or 9 weeks of pregnancy. This is the moment when the normal vs molar pregnancy difference becomes obvious.

In the case of a partial molar pregnancy, the following could be seen: low amniotic fluid, a growth-restricted fetus; a thick cystic placenta and others.

Molar Pregnancy Treatment

Pregnancy after partial molar pregnancy

In most of the cases the molar pregnancy will end by itself and grape-like formations will be expelled. This does not mean that you should not do anything about it. The medical supervision and intervention, if needed, can prevent serious complications.

If the doctor considers it is necessary, suction curettage, dilation and evacuation (D & C will be made to remove the molar tissue). General anesthetic and some other drugs might also be used. Around 90% of women with a molar pregnancy require no further treatment. Usually, the only needed therapy afterward it the psychological one. It is especially important to help the mother cope with the loss and take decisions for her future.

Health Monitoring after a Molar Pregnancy

After the end of a molar pregnancy, it is important the doctor to monitor your hCG levels monthly for the next six months. This is essential because traces of the mole can begin to grow again and this cancerous formation might endanger your life.

Can I Get Pregnant Again?

A new pregnancy should be avoided in the next year after a molar pregnancy. You can use any birth control method, except an intrauterine device. After this year, pregnancy after partial molar pregnancy and after a complete one are both possible.

The Emotional Side of a Molar Pregnancy

Realizing that what happens in your body is not the normal development of a baby, is quite traumatic. Even if the doctor discovers your condition on time and prevents complications, you will still have to live with your loss. You should look for the support of a psychologist or the one of your family and friends. If you succeed to accept what happened, you might try to have a baby a year later.

Give yourself enough time to live through this emotional trauma. Do not let anyone tell you how you should feel. You are the only one who could decide whether you are fine and whether this is the time to get pregnant again.

Am I At Risk of a Molar Pregnancy?

Before you get pregnant, you should consult with your doctor if you are concerned that you might get a molar pregnancy. The risk is higher for women over the age 35 or younger than the age of 20. If you have had a molar pregnancy once, you are also at a higher risk. The average repeat molar pregnancy rate is 1 to 2 out of every 100 women. You should consider counseling a conceiving agent together with your partner.

Molar Pregnancy Complications

Molar tissue acts as a cancerous one which makes it quite dangerous. After the molar pregnancy has been removed by the doctor, some molar tissue might remain and continue to grow. This condition is known as a persistent gestational trophoblastic disease (GTD). The risk is relatively high, since this problem occurs in about 1 of every 5 women. It is more common after a complete molar pregnancy rather than after an incomplete one.

Persistent GTD

The high levels of HCG after the molar pregnancy has been removed show that you might have a persistent GTD. In some of the cases, an invasive mole penetrates deep into the middle layer of the uterine wall and causes vaginal bleeding. If treated on time, persistent GTD can nearly always be completely cured. Usually, chemotherapy needs to be used. Sometimes, the removal of the uterus is necessary. This intervention is called hysterectomy. A rare and cancerous form of GTD - choriocarcinoma might develop and spread to other organs. This condition is very dangerous and needs to be treated with multiple cancer drugs.

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