Molar Pregnancy : Causes, Clinical manifestations, Diagnosis, and Treatment

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What is a molar pregnancy?
A molar pregnancy occurs when an egg and sperm join incorrectly at fertilization and a noncancerous tumor forms instead of a healthy placenta. The tumor, or mole, cannot support a developing embryo, and the pregnancy ends. It is also called a hydatidiform mole.

Molar pregnancies are a type of gestational trophoblastic disease. In a molar pregnancy, a tumor grows in the uterus. The tumor forms as fluid-filled cysts resembling clusters of grapes.

Who is likely to have a molar pregnancy?
Although molar pregnancies are very rare, anyone can have a molar pregnancy. You are more likely to have a molar pregnancy if you:

Are younger than age 20
Are over age 40
Have a history of molar pregnancies
Have had two or more miscarriages
Live in certain geographical locations, including the Philippines, Southeast Asia and Mexico
In the United States, women of European heritage have a higher risk of molar pregnancy compared to women of other ethnicities.

How common are molar pregnancies?
Less than 1% of all pregnancies – about 1 in 1,000 – are molar pregnancies.

What are the types of molar pregnancies?
Molar pregnancies fall into two categories: complete and partial.

In complete molar pregnancies, the tissue making up the placenta is abnormal, and no embryo forms. The tumor still forms and produces the pregnancy hormone HCG, which is made by healthy placentas during normal pregnancies. HCG levels are measured by many pregnancy tests.

A partial molar pregnancy occurs when an abnormal placenta forms along with an embryo. In these cases, embryos have severe birth defects. The developing tumor quickly overcomes the embryo.

What causes a molar pregnancy?
Molar pregnancies result when specific genetic errors occur during the fertilization of an egg by a sperm.

In a healthy pregnancy, a placenta forms to nourish the growing embryo. With a molar pregnancy, instead of a placenta, a tumor forms inside the uterus. A developing embryo is almost never involved in a molar pregnancy.

Occasionally, molar pregnancies develop after a miscarriage, a successful pregnancy, or an ectopic pregnancy, when cells remain in the uterus. In an ectopic pregnancy, a fertilized egg implants outside the uterus.

What are the symptoms of a molar pregnancy?
The most common symptoms of molar pregnancy include:

Vaginal bleeding within the first three months of pregnancy
Severe nausea and vomiting.
Preeclampsia (extremely high blood pressure)
High HCG levels
Increases in abdominal size that occur much faster than in a healthy pregnancy
No heartbeat or fetal movement
Grape-like cysts coming out of the vagina

How is a molar pregnancy diagnosed?
Your doctor diagnoses a molar pregnancy by obtaining an ultrasound of your uterus. An ultrasound uses sound waves to produce pictures of your uterus. Your doctor may also recommend blood tests to check your HCG levels.

How is a molar pregnancy treated?
Most molar pregnancies spontaneously end on their own. In these cases, grape-like cysts pass out of the uterus and through the vagina naturally.

Some women require treatment to remove molar pregnancies. Treatment involves dilation and curettage (use of a tool to remove tissue) with suction to remove all abnormal tissue from the uterus.

In rare cases, a hysterectomy, or surgical removal of the entire uterus, is necessary to treat a molar pregnancy.

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  Gestational Trophoblastic Disease