Everything about molar pregnancy, its symptoms and treatments. Read the article to find out what to do in case of a possible molar pregnancy.
When Barbara Garcia of Ammon, Idaho discovered she was pregnant in December 2016, her first reaction was one of surprise. “This was an unplanned pregnancy,” she says. “But once the initial shock wore off, my husband and I were thrilled to be expecting our first baby.”
Like all expectant moms, Garcia started planning and dreaming of the day she would hold her baby in her arms, but her pregnancy was difficult from the beginning. “For 16 weeks, I had extreme morning sickness and fatigue, as well as consistent spotting,” she says. These symptoms concerned her doctor, who ordered an ultrasound to find out what was wrong. When Garcia received the results, they were more shocking than finding out she was pregnant. The diagnosis was a hydatidiform mole, also known as a molar pregnancy.
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What Is It?
“Molar pregnancy is a very confusing and complicated disease,” says Dr. Arleen A. White, an OB/GYN. “If you receive this diagnosis, make sure your doctor spends a good deal of time explaining it to you and answering your questions.”
There are actually two types of molar pregnancies: complete and partial. In a complete molar pregnancy, there is no fetus, only an abnormal placenta that is large and swollen. “Partial molar pregnancies can occur where a fetus will form,” Dr. White says. “But the fetus is usually abnormal and dies early in the pregnancy.” It is estimated that, in the United States, molar pregnancy occurs in one of every 1,000 to 1,500 pregnancies.
“Molar pregnancy is caused by genetic problems that occur when the sperm and egg come together,” says Dr. White, who adds that it is not clear why this abnormal fertilization takes place. And although molar pregnancies are slightly more common in women older than 40, there are no real risk factors, according to Dr. Derek Wilson, professor and chairman of the department of OB/GYN.
As Garcia experienced, most molar pregnancies cause symptoms that alert the woman and her doctor that something is wrong. “The most common symptom is vaginal bleeding in the first or second trimester,” says Dr. White. Other symptoms may include extreme nausea, excessive vomiting and high blood pressure. You can check our article about nausea : Ways to Reduce Nausea in Pregnancy.
The uterus also may be larger than expected for the stage of pregnancy, because of the large and swollen placenta, although this isn’t something a woman will notice on her own; it is generally discovered by the doctor during a medical examination.
If the doctor suspects a molar pregnancy, an ultrasound will be performed to confirm the diagnosis. “The ultrasound will show the absence of a fetus, and a placenta that has a snowstorm appearance,” notes Dr. Wilson. A blood test to measure the level of human chorionic gonadotropin (hCG), the pregnancy hormone, is also important. “In complete molar pregnancies, the hCG level may be much higher than normal,” says Dr. White.
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What Happens Now?
When a molar pregnancy is confirmed, the woman will quickly have a procedure called a dilation and curettage (D&C), “which is the removal of the abnormal tissue from the uterus using a suction tube,” says Dr. White. This was the case for Garcia. “Two days after the diagnosis, I underwent a D&C,” she says.
Although most women whose molar pregnancies are removed will require no further treatment, follow-up care after the D&C is extremely important. “It is very important that the woman gets her hormone levels checked regularly for at least a year and that she has regular doctor visits,” advises Dr. White. This is because there are several complications that, although rare, are very serious and require immediate diagnosis and treatment. These complications occur when abnormal cells remain in the body after the molar pregnancy has been removed. These cells, which can include invasive moles, says Dr. White “are usually diagnosed when the hormone levels do not drop after the D&C,” and can also include choriocarcinoma, which is a form of cancer. Both invasive moles and choriocarcinoma are treated with chemotherapy and “the prognosis is excellent with treatment,” notes Dr. White.
Garcia’s follow-up care was comprehensive and lasted for a year after her molar pregnancy. “My doctor ordered baseline chest x-rays to ensure that the tissue had not spread to the lungs,” she recounts. “I then started weekly blood draws [to monitor my hCG levels].” Two weeks later, she had another ultrasound because her hCG was not dropping as expected. “Thankfully, the ultrasound revealed no remaining or spreading tissue,” she says. “The hCG was just slow in dropping.”
What Happens Then?
Garcia continued the weekly blood tests until her hCG level returned to normal. “This took approximately four months,” she notes. “After that point, I had blood tests every other month for six months – a total of three tests – to ensure that the hCG stayed down.” After the three normal tests, “we were given the green light to try for another child.”
During the follow-up period, “effective birth control is a must,” advises Dr. Wilson. Dr. White agrees and adds that another pregnancy should be delayed during this time “because a new pregnancy will cause the hCG levels to rise and prevent detection of an invasive mole.” However, once a woman is given the go-ahead to try to conceive again, she should not experience any fertility problems due to the previous molar pregnancy. The recurrence rate of molar pregnancy is also low – about 1 to 2 percent, according to Dr. Wilson, who says “a new pregnancy should not be affected by the history of molar pregnancy.”
If you’re concerned about pregnancy tests, you can read our article on this topic: Pregnancy Tests: Types and Results.
This was the case for Garcia. “We were given the green light to try for another child in January 2018,” she says. “We conceived in February 2018.” Her story gets even better. “After a very easy and successful pregnancy, I gave birth to my son the following November.”
The names of the people mentioned in the article have been changed for security reasons.