Overview

Pregnancy the fertilisation of an egg which then implants itself into the lining of the uterus. However, disruptions in the process may occur, resulting in the development of a molar pregnancy. This type of pregnancy is characterised by the abnormal growth of the placental tissue, which instead of developing normally, becomes a mass of fluid-filled sacs or cysts and is unable to support the development of the embryo.

A molar pregnancy, also known as a hydatidiform mole, is a rare type of pregnancy that generally occurs because of the presence of certain chromosomal abnormalities at the time of conception that leads to the placental tissue growing abnormally. Despite management, a molar pregnancy is mostly non-viable as the foetus is unable to survive and may result in a miscarriage. 

Types of Molar Pregnancy

The two types of molar pregnancy include: -

• Complete Molar Pregnancy: Complete molar pregnancies develop when there is no embryo formation, as the sperm ends up fertilising an empty egg that contains no genes from the mother. In such cases, no foetus is formed because of the egg being empty, but the placenta keeps growing, producing hCG, the pregnancy hormone, which can give positive results in pregnancy tests. The result of this type of molar pregnancy is an abnormal placental tissue swelling that forms fluid-filled cysts.

• Partial Molar Pregnancy: A partial molar pregnancy generally occurs when an egg is fertilised by two sperms, resulting in an embryo with three sets of chromosomes instead of two. In this type of molar pregnancy, abnormal placental tissue develops alongside an embryo with severe birth defects. With the chromosomal defects of the embryo and the inability of the placenta to support foetal development, the embryo is almost always overcome by the abnormal tissue and cannot develop into a foetus. In extremely rare cases, and with careful management, a molar pregnancy may even be carried to term.

Symptoms of Molar Pregnancy

Most signs and symptoms of molar pregnancy are similar to those of a regular pregnancy. However, in some cases, certain symptoms of molar pregnancy might develop. These include:

• Vaginal bleeding that may range from light spotting to heavy bleeding.
• Severe nausea/vomiting
• Passing grape-like cysts through vaginal discharge
• Pressure or pain in the pelvis

Several symptoms of partial or complete molar pregnancy resemble the symptoms of various other medical issues, so it is always a good idea to seek medical attention immediately if any signs and symptoms of molar pregnancy start to show. In most cases, both types of molar pregnancy can be detected within the first trimester, but if they are not, other symptoms of partial or complete molar pregnancy may start appearing. These include:

• The abnormally fast growth of the uterus which becomes too large too early.
• Excessively high levels of pregnancy hormones, caused by unusually large amounts of placental tissue. The hCG hormone is also what causes nausea and vomiting as well.
• Preeclampsia, which is a condition that causes the blood pressure and protein content in urine to rise, is another symptom of molar pregnancy that generally occurs before the 20-week gestation mark.
• Hyperthyroidism, or a hyperactive thyroid gland.

Causes of Molar Pregnancy

The causes of molar pregnancy include atypical egg fertilisation. Sometimes it is caused by an empty egg being fertilised, resulting in an embryo with no genes from the mother and only the father’s gene’s that are copied (complete molar pregnancy). In other cases, a normal egg is fertilised by two sperm, resulting in two copies of the father’s genes and one copy of the mother’s genes (partial molar pregnancy) to create an embryo that has 69 chromosomes instead of the usual 46.

There are several risk factors that increase one’s chances of developing a molar pregnancy, including:

• 
  
• Genetic factors like chromosomal or gene abnormalities that cause abnormal uterine or placental growth.
• Empty or abnormal eggs that do not grow completely before a sperm attaches to it. 
• Causes of molar pregnancy may also include a normal egg getting fertilised by abnormal sperm.
• Conceiving before the age of 20.

Treatment of Molar Pregnancy and Management Practices

• Timely treatment of molar pregnancy is extremely important for avoiding complications in the future. In many cases, there is no need for management of the molar pregnancy as it generally ends spontaneously in a miscarriage.
• If some tissue is left remaining, it may lead to the development of persistent gestational trophoblastic disease. So, on detection of a molar pregnancy, medication or a medical procedure called D&C may be prescribed by the doctor.
• Post completion of medication or the medical procedure, the molar pregnancy must be monitored for some months. This may include regular hCG blood tests to ensure reduced risk of complications.
• Management of molar pregnancy post treatment may also include regular follow-ups for ensuring that the mole has been removed completely and there are no signs of growing again.
• Conception should be avoided for at least one year after molar pregnancy treatment.

In cases where complications seem likely, undergoing a medical procedure for molar pregnancy treatment may be prescribed as well. These include:

• Dilation and Curettage (D&C)

The abnormal tissue forming in the womb can be removed through dilation and curettage (D&C), which involves dilating the cervix, after which a suction pump is used to remove the abnormal placental and/or dead foetal tissue.

• Hysterectomy

In rare cases, a hysterectomy may have to be performed, where the uterus or a part of it is removed. This medical procedure for molar pregnancy is usually reserved for instances with high risks of fatal complications developing or if there is a high chance of developing molar pregnancies in the future.

• Radiation Therapy

Radiation therapy may also be used to control the abnormal growth of the placenta. This is usually recommended in cases where there is a risk of recurrence or where the growth has rare cancer predispositions.

Early detection and treatment are crucial for effective management of molar pregnancy and can significantly help avoid serious complications.

When to See an OB/GYN?

If a pregnant woman starts displaying indicative signs and symptoms of partial molar pregnancy or complete molar pregnancy, like vaginal bleeding, severe nausea and/or vomiting, grape-like cysts being passed through vaginal discharge, etc., they should seek immediate medical attention. Quick detection and treatment of molar pregnancy is essential for preventing potential complications from arising. Whether it is for diagnosis or detection or to monitor whether the treatment has been effective, one can conveniently book online appointments at Max Lab for quick and accurate test results. We also offer an at-home sample collection service and the test reports, once generated, are made available for download on our website for your ease.