Molar Pregnancy (Hydatidiform mole)
This is a rare pregnancy complication that is characterized by the abnormal growth of the
trophoblasts (the cells that normally develop into the placenta).
Molar pregnancy is of two types:
- Complete molar pregnancy
- Partial/incomplete molar pregnancy
Complete molar Pregnancy
The placental tissue is abnormal and swollen. They appear to form fluid-filled cysts. It should be
noted that there is no formation of fetal tissue.
Partial molar pregnancy
In this case, there are normal placental tissue as well as abnormal forming placental tissue.
Although there is formation of a fetus, it is unable to survive and there’s usually a miscarriage
early in the pregnancy.
Causes
A molar pregnancy is caused by an abnormally fertilized egg. Human cells normally contain 23
pairs of chromosomes.
In a complete molar pregnancy, an empty egg is fertilized by one or two sperms. All of the
genetic material comes from the father. The chromosomes from the mother’s egg are lost or may
be inactivated while the father’s chromosomes are duplicated to make up for the 23 pairs of
chromosomes needed.
In an incomplete molar pregnancy, an egg is fertilized by two sperms. Thus, the mother’s
chromosomes remain while the father provides two sets of chromosomes. Therefore, the embryo
will have a total of 69 chromosomes (2 sets of 23 chromosomes from the father and a set of 23
chromosomes from the mother). This occurs usually when two sperms fertilize an egg, which
will result in an extra copy of the father’s genetic material.
Signs & Symptoms
A molar pregnancy may seem like a normal pregnancy in the beginning. However, we must not
ignore the specific signs and symptoms of a molar pregnancy. These include:
Complete Molar Pregnancy
a. During the first trimester (first three months), there is dark brown to bright red vaginal
bleeding The most common classic symptom of a complete mole. It is caused by the
separation of the molar tissue from the decidua. This symptom occurs in 50% of cases.
b. Severe nausea and vomiting (This is normal in a normal pregnancy and won’t raise an
alarm that this is a sign & symptom of molar pregnancy). This is due to extremely high
levels of human chorionic gonadotropin (hCG).
c. Hyperthyroidism- This is overproduction of the hormones, thyroxine by the thyroid
gland.
Partial Molar Pregnancy
-Patients usually present signs or symptoms that corresponds with an incomplete or missed
abortion e.g., vaginal bleeding, absence of fetal heart tones.
Common to both types would be
d. Vaginal passage of grapelike cysts
e. Pelvic pressure/pain
It is still important to have regular clinical checkups because the doctor may detect other signs of
molar pregnancy. This will include:
a. Rapid uterine growth- The uterus becomes too large for the stage of pregnancy
b. High blood pressure
c. Preeclampsia- common with Partial Pregnancy
d. Ovarian Cysts
e. Anemia
f. Overactive thyroid
Diagnosis
This is made based on blood tests and scanning techniques. A blood test would be used to
measure the level of HCG and an ultrasound would be used to check for the presence of the
embryo and its development.
Risk Factors
It was mentioned earlier when we were defining molar pregnancy that is a rare pregnancy
complication. Approximately 1 in every 1,000 pregnancies is diagnosed as a molar pregnancy.
However, two other risk factors that we should examine would include:
1. Age of the mother- A molar pregnancy is more likely to occur in women younger than 20
or older than 35 are at a greater risk of this occurring which is why at a certain age
women are advised to freeze their eggs in preparation for a future pregnancy.
2. The existence previous molar pregnancy- Experiencing one molar pregnancy, increases
your chance of experiencing another.
3. Previous miscarriage
4. Dietary deficiencies- mainly a lack of beta carotene. We can find those in carrots and
generally orange fruits and vegetables. The purpose of beta carotene is for the
development of the embryo.
Treatment
Treatment consists of evacuation of the uterus by dilation and curettage (D&C) procedure to
remove tissue from inside your uterus.
Medical evacuation- using a drug treatment to cause the womb to contract and release the
abnormal tissue.
Complications
Molar tissue may remain and continue to grow even after a molar pregnancy has been removed.
The occurrence of this is known as Persistent Gestational Trophoblastic Neoplasia (GTN). This
happens in about 15 – 20% of complete molar pregnancies while up to 5% in incomplete molar
pregnancies.
A sign of GTN is a high level of Human Chorionic Gonadotropin (HCG) after the removal of the
molar pregnancy. Persistent GTN can almost always be treated successfully with the aid of
chemotherapy. There is also the option of removal of the uterus (hysterectomy).
Prevention
If you had a molar pregnancy, you’ll find that your doctor recommends waiting 6 months to a
year before trying to become pregnant again. This is advised because as my previous colleague
mentioned, molar tissue could remain and grow and GTN can occur. Additionally, an elevated
level of HCG is a sign for GTN. So having another pregnancy, would increase the level of HCG.
Therefore, doctors won’t be able to distinguish the pregnancy from the GTN.
Early ultrasounds to monitor the development of the fetus is also another preventative measure
that can be taken.
References
Cancer Research UK. (2019, May 31). Types of treatment for molar pregnancy.
https://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd/
molar-pregnancy/treatment/types
Iftikhar, N. (2019, August 30). Molar pregnancy: Symptoms, causes, treatment, pictures, and
more. Healthline. https://www.healthline.com/health/pregnancy/molar-
pregnancy#takeaway
Mayo Clinic Staff. (2021, May 13). Molar pregnancy - Symptoms and causes. Mayo
Clinic. https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-
causes/syc-20375175
Moore, L, MD. (2021, April 29). Hydatidiform Mole Clinical Presentation: History, Physical
Examination. Medscape. https://emedicine.medscape.com/article/254657-clinical#b1
