Overview
A molar pregnancy is a rare complication of pregnancy characterized by unusual growth of trophoblast cells, which form the placenta. There are two types: complete and partial. In a complete molar pregnancy, there is no fetus and the placental tissue swells and forms fluid-filled cysts. In a partial molar pregnancy, there may be a fetus, but it is non-viable and often results in a miscarriage. Molar pregnancies can have serious complications and require early treatment due to the risk of cancer.
Understanding the disease
Symptoms
The symptoms of a molar pregnancy may include dark brown to bright red bleeding from the vagina during the first three months, severe nausea and vomiting, grapelike cysts passing from the vagina, pelvic pressure or pain, a uterus growing too large too early in the pregnancy, preeclampsia, ovarian cysts, and overactive thyroid (hyperthyroidism).
Risk Factors
Risk factors for developing a molar pregnancy include:
- A history of a previous molar pregnancy: If you've had one molar pregnancy, you are more likely to have another, occurring on average in 1 out of every 100 people.
- Age of the mother: Molar pregnancies are more likely to occur in individuals who are older than 43 or younger than 15. It is essential to seek medical attention if you experience any symptoms of a molar pregnancy or if you have concerns about your pregnancy. Early detection and treatment are crucial to prevent potential complications.
Development
A molar pregnancy develops when there is an abnormal growth of cells called trophoblasts, which are responsible for forming the placenta. There are two types of molar pregnancy: complete and partial. In a complete molar pregnancy, the placental tissue swells and forms fluid-filled cysts, with no fetus present. In a partial molar pregnancy, the placenta has both regular and irregular tissue, and there may be a fetus, but it can't survive. The fetus is usually miscarried early in the pregnancy. A molar pregnancy can lead to complications, including a rare form of cancer.
Assessment and Diagnosis
Triage
If you suspect a molar pregnancy, it is essential to see a doctor as soon as possible. Early detection and treatment of a molar pregnancy are crucial due to the potential complications and risks associated with the condition. If you experience any symptoms of a molar pregnancy, such as dark brown to bright red bleeding from the vagina, severe nausea and vomiting, or a uterus growing quickly and being too large early in the pregnancy, you should consult a healthcare provider immediately. Additionally, if you have a history of molar pregnancies or fall into high-risk categories, such as being older than 43 or younger than 15, it is important to receive regular prenatal care and monitoring to minimize potential risks.
Diagnosis
To diagnose a molar pregnancy, a health care provider will likely order blood tests and an ultrasound. An ultrasound can detect the presence of a molar pregnancy as early as eight or nine weeks of pregnancy. It may show no embryo or fetus, no amniotic fluid, and a thick cystic placenta nearly filling the uterus. In the case of a partial molar pregnancy, an ultrasound may show a fetus that's smaller than expected, low amniotic fluid, and an unusual placenta. After diagnosing a molar pregnancy, a health care provider may check for other medical issues such as preeclampsia, hyperthyroidism, or anemia.
Management and Treatment
Complications
Potential complications of molar pregnancy include persistent gestational trophoblastic neoplasia (GTN), where molar tissue remains and continues to grow after removal, and high levels of human chorionic gonadotropin (HCG) after the molar pregnancy has been removed. GTN may require chemotherapy or hysterectomy for treatment. Other complications can include preeclampsia, ovarian cysts, and overactive thyroid.
Treatment
Treatments for molar pregnancy include chemotherapy and, in some cases, hysterectomy (removal of the uterus). If persistent gestational trophoblastic neoplasia (GTN) occurs, characterized by a high level of human chorionic gonadotropin (HCG) and the molar tissue remaining and growing after the molar pregnancy has been removed, chemotherapy is usually the treatment option. In rare cases where choriocarcinoma, a cancerous form of GTN, develops and spreads to other organs, chemotherapy is also the successful treatment option. It is important to note that if you've had a molar pregnancy, it's recommended to consult your pregnancy care provider before attempting another pregnancy. You may need to wait for six months to a year before trying again. In future pregnancies, your care provider may conduct early ultrasounds to monitor your condition and the baby's development.
Preparing for medical consultation
To prepare for an appointment for molar pregnancy, you can:
- Gather information: Compile a list of your symptoms, including when they started and how they've changed over time. Note the date of your last menstrual period, if you remember it. Also, prepare a list of your key personal information, such as other medical conditions you have, and all medications, vitamins, or supplements you take, including doses.
- Bring a support person: Ask a friend or family member to accompany you to your appointment, as having someone there can help you remember the information you receive.
- Prepare questions: Create a list of questions to ask your healthcare provider. For molar pregnancy, consider asking about the cause of your symptoms, the necessary tests, recommended treatment, any restrictions to follow, emergency symptoms to watch for at home, and your future chances of giving birth. Remember to be open and honest with your healthcare provider about your concerns and symptoms, as this will help them provide the best possible care and guidance.