Miscarriage is a devastating event in the life of a woman, but, in most cases, physical recovery is fast.
Molar pregnancy is an exception to this rule.
It can lead to serious complications, this is why the patient has to stay under her OBGYN’s observation for more months, after the procedure: suction curettage, dilation and evacuation (D & C) etc.
Usually molar pregnancy is successfully treated, without severe complications, but the added stress can hinder psychological recovery.
Types of molar pregnancy
This type of ‘false’ pregnancy appears because the egg is incorrectly fertilized.
Normally, the cells in our body contain 23 pairs of chromosomes (one chromosome from each pair coming from the father, the other one from the mother).
Complete molar pregnancy
One egg, without any genetic information, is being fertilized by a sperm, but it doesn’t turn into an embryo, but grows into an abnormal tissue, which looks like grapes and can fill the uterus.
In this case, there’s no placenta or normal embryo, so we cannot talk about a viable pregnancy.
The chromosomes come only from the father, the ones from the mother are inactivated or lost after the fertilization, while the father’s chromosomes double.
Partial molar pregnancy
An egg is being fertilized by 2 sperm cells. The placenta turns into a mola. The embryo starts to develop, but it’s malformed and it will not survive.
In this case the mother’s chromosomes remain, while the father’s double, so the embryo will have 69 chromosomes instead of the normal 46.
About 20% of the women with molar pregnancy can develop 1 or 2 severe complications: myometrial invasion and Choriocarcinoma.
The risk of such complications gets higher, if the treatment is postponed. The more a patient is waiting, the bigger the chances for complications.
Invasive mole can appear pre and post treatment.
Choriocarcinoma is a neoplasic process starting at placenta level and rapidly expanding throughout the body. Even if this is a very severe complication, it can be cured with chemotherapy.
Both these complications appear with complete molar pregnancy, changes for a partial molar pregnancy to lead to these complications is as low as 2-4%.
Molar pregnancy risk factors
- age – under 20 and over 35 years
- race – for women of color, molar pregnancies are more common
- previous molar pregnancies – women who already had a molar pregnancy develop a higher risk of having another one.
- previous miscarriage(s)
- viral and parasitic infections, such as Toxoplasmosis
- hormonal imbalance
- immune disorders
Molar pregnancy symptoms
The women who develop molar pregnancy have no particular symptoms at first, but can show high HCG levels, an engorged uterus, bigger ovaries and early preeclampsia.
Vaginal bleeding appears in most molar pregnancy cases, but it can be a normal sign of miscarriage risk even in regular pregnancies.
Severe nausea and vomiting (but these can also occur in typical pregnancies).
How molar pregnancy can be diagnosed
- complete pelvic exam
- ultrasound examination
- hormonal dosage to find out the exact levels of serial β-HCG
In some rare cases a twin pregnancy can have a normal embryo and another one with molar transformation.
Continuing the pregnancy can determine severe complications for the mother.
How molar pregnancy is treated
A molar pregnancy is NOT a normal pregnancy and it won’t end with a viable fetus. This is why the only treatment option is to remove the mola.
A suction curettage is required. Only if serial HCG is high afterwards, cytostatic treatment would be required.
Monitoring the patient
In order to prevent serious life-threatening complications, the patient has to be constantly monitored with repeated serial HCG dosing, until it gets negative.
If for 3 months its level is negative, the patient is considered healed.
Please do consider using contraceptives for the next 6 months, since there is a very high risk of developing another molar pregnancy this soon.
If the serial HGC levels are high again, your doctor will prescribe a cytostatic treatment.
A molar pregnancy is a very traumatic experience for any woman, this is why we also recommend you get all the family support and, if needed, of a good therapist. The good news is that you can conceive afterwards, once you are fully recovered, so don’t lose hope.