Molar Pregnancy (Hydatidiform Mole) is an incomplete pregnancy where the embryo and placenta do not develop normally. The embryonic tissue then develops into a benign tumor in the uterus, which looks like a bunch of white grapes or moles instead.
The placenta normally transports nutrients to the fetus and removes waste products. If the cells that make up the placenta malfunction after the fertilization of an egg with sperm , an ovarian cyst or cyst that resembles a fish egg will develop rapidly inside the uterus instead of developing into a baby, which is called a molar pregnancy. Although a molar pregnancy is a benign tumor, it is considered a pre-cancerous condition of the molar egg or placental cancer (choriocarcinoma).
Causes of molar pregnancy
There are two types of molar pregnancy: complete molar pregnancy and partial molar pregnancy, which have different characteristics depending on the balance of chromosomes in the egg.
Molar pregnancy alone is a condition in which there are only abnormal cells and no embryo. Molar pregnancy with fetus is a condition in which abnormal cells develop along with the abnormal embryo. As a result, the embryo cannot grow. In addition, women who are pregnant with twins may also experience molar pregnancy, but this is not common. One embryo develops normally and the other embryo develops into a tumor that destroys the growing embryo.
The cause of both types of molar pregnancies is due to chromosomal abnormalities within the fertilized egg. Generally , an egg fertilized with sperm will have an equal number of 23 chromosomes, which are inherited from the father and mother, resulting in a normal pregnancy and development into a baby. As for pregnant women who experience molar pregnancies, they will have chromosomal abnormalities, which are divided according to the types of molar pregnancies as follows:
- Unilateral molar pregnancy: The fertilized egg contains all the paternal chromosomes, resulting in no embryo, amniotic sac, or placenta developing inside the egg. Instead, numerous ovarian cysts, resembling clusters of grapes, develop.
- Mole pregnancy with fetus: The fertilized egg contains 23 maternal chromosomes and twice as many paternal chromosomes, or 46, resulting in a total of 69 chromosomes. This condition is caused by a duplication of paternal chromosomes or by two sperm fertilizing the same egg. Most babies that develop are abnormal or do not survive.
In addition, pregnant women can be at risk of molar pregnancy if they have the following risk factors:
- Age over 35 yearsis at high risk of molar pregnancy only. However, age is not a risk factor for molar pregnancy with associated fetus.
- Those who have a history of molar pregnancy, especially those who have experienced this condition many times, are at higher risk of recurrence.
- Have a history of miscarriage
- Eating foods that are low in folic acid or carotene can result in insufficient vitaminintake , which can result in molar pregnancy, a type of molar pregnancy that is only molar.
However, molar pregnancy is a rare condition, affecting about 1–3 out of every 1,000 pregnancies. Those who experience this condition need to seek immediate medical attention, as molar pregnancy can lead to serious complications that can be life-threatening.
Symptoms of molar pregnancy
Mole pregnancy symptoms are similar to the symptoms of general pregnancy, such as missed periods or morning sickness. It also has symptoms similar to miscarriage. Most pregnant women often misunderstand that mole pregnancy symptoms are miscarriage symptoms. Those who experience mole pregnancy will experience the following symptoms:
- Vaginal bleedingin early pregnancy, usually starting around 4 weeks of pregnancy or as late as 12 weeks. The blood can be dark brown to light red and sometimes contains grape-like tissue.
- Sudden abdominal painand a uterus that is larger than normal, causing squeezing or pressing pain in the pelvis, as well as abdominal swelling.
- Severe nauseaand vomiting
- Fatiguedue to heavy vaginal bleeding
- Symptoms of hyperthyroidisminclude feeling anxious or tired, having a faster than normal heartbeat, or sweating excessively .
- Preeclampsiaoccurs , which causes high blood pressure and protein in the urine.
- Pregnant women with ovarian cancer may also experience other symptoms, such as shortness of breath or coughing up blood,because the ovarian cancer has spread to the lungs before diagnosis.
Symptoms of molar pregnancy that require seeing a doctor
Pregnant women who experience vaginal bleeding should see a doctor immediately because the symptoms are also related to other dangerous conditions that affect the health of the pregnancy. In addition, if there is severe nausea and vomiting and grape-like tissue coming out of the vagina, a doctor should be seen immediately to receive an ultrasound and blood test to diagnose the cause of the symptoms.
Diagnosis of molar pregnancy
Doctors will diagnose molar pregnancy based on the symptoms that occur during pregnancy, the size of the uterus, and the level of the hormone hCG (Human Chorionic Gonadotropin), which is a pregnancy hormone. The test for molar pregnancy is as follows:
- Blood test:The doctor will take blood from the pregnant woman to test the hCG hormone level, which is a hormone used to detect pregnancy. Pregnant women with higher than normal levels of this hormone may have anovulatory pregnancy.
- Ultrasound: The doctor will use an ultrasound to look at the tissues inside the pregnant woman’s abdomen and pelvic area.
- Pelvic exam: The doctor will examine all of the internal organs in the pelvis to check the size and position of the vagina, cervix, uterus, and ovaries.
- A computerized tomography(CT) scan or magnetic resonance imaging (MRI) scan, in which the doctor examines the chest, abdomen, pelvis and brain, can help diagnose the type of molar pregnancy and the likelihood of an ectopic molar pregnancy.
In addition, the doctor will check for other pregnancy health problems, such as preeclampsia, hyperthyroidism, anemia, and take a chest X-ray to see if abnormal cells from the molar pregnancy have spread to the lungs. However, it is rare for such cells to spread to other parts of the body. If this type of spread occurs, the cells most often spread to the lungs.
Treatment of molar pregnancy
Pregnant women who are diagnosed with molar pregnancy cannot continue their pregnancy and should seek treatment to prevent complications in the following ways:
D&C: The doctor will scrape the uterus to remove the tumor. The doctor will inject local anesthesia or sedation to the pregnant woman and put her in stirrups to prepare for the D&C. Then, a duck-billed instrument will be inserted into the vagina and the uterus will be scraped and the uterine tissue will be sucked out. This procedure takes about 15-30 minutes.
Chemotherapy: Doctors will perform chemotherapy for women with molar pregnancy tumors that are at risk of becoming cancerous or women who have had surgery to remove the tumors but the hCG hormone levels have not decreased to normal. Pregnant women whose symptoms are likely to be good will receive chemotherapy and a single drug. Pregnant women whose symptoms are likely to be dangerous will receive chemotherapy in combination with other drugs.
Hysterectomy: This is not a very common treatment. However, doctors will perform a hysterectomy if the pregnant woman has a large number of molar tumors that are at risk of becoming cancerous and does not want to have children in the future.
After the molar tumor is removed, the doctor will monitor the hCG hormone levels to make sure that the hormone levels have decreased and that no molar tumors remain, as women with molar tumors are at risk of developing choriocarcinoma. The follow -up will be for 6 months.
For those whose tumors remain and grow outside the uterus, which is Gestational Trophoblastic Neoplasia, the doctor will monitor hCG levels for 1 year after chemotherapy.
In addition, during the hormone monitoring period, the patient must use birth control for 6 months to 1 year to allow the hCG hormone level to disappear. If a pregnancy occurs before the specified period, the hCG hormone level will increase, making it difficult to diagnose whether the molar tumor will recur.
Doctors may perform internal examinations, ultrasounds, or X-rays on the patient as appropriate . However, women who experience molar pregnancy will not experience infertility or pregnancy health problems. They are also not at risk of stillbirth, birth defects , premature birth , or other complications. The chance of molar pregnancy occurring in subsequent pregnancies is only 1–2 percent .
Complications of molar pregnancy
After undergoing treatment to remove the tumor, it may remain and grow again, possibly growing outside the uterus and spreading to other muscle tissue. This condition is called Gestational Trophoblastic Neoplasia. Women who have only molar pregnancy are more likely to develop this condition than women who have molar pregnancy with a fetus.
Some women with this condition may develop tumors that invade the middle layer of the uterine lining, which can cause vaginal bleeding and may also be at risk for developing choriocarcinoma . Gestational Trophoblastic Neoplasia and Choriocarcinoma can be treated with chemotherapy and radiation.
In addition, molar pregnancy can also lead to other complications such as high blood pressure, low blood pressure, bloodstream infections , and uterine infections.
Prevention of molar pregnancy
Pregnant women under the age of 20 or over the age of 40 are at high risk of experiencing pregnancy-related health problems, including molar pregnancy. However, the best way to prevent complications from molar pregnancy is to strictly attend prenatal check-ups as scheduled .
Pregnant women who have experienced molar pregnancy should see a doctor to receive advice on how to manage their next pregnancy to prevent this condition from happening again. The doctor will recommend that the patient wait approximately 6 months to 1 year before starting a new pregnancy. The doctor will perform an ultrasound sooner to monitor the treatment and check the overall health of the pregnancy to ensure there are no abnormalities.
