Molar Pregnancy

A molar pregnancy, also known as Gestational Trophoblastic Disease (GTD), is a rare complication of pregnancy where abnormal tissue grows inside the womb (uterus) instead of a healthy baby.

In a normal pregnancy, cells called trophoblasts develop into the placenta. In a molar pregnancy, these cells grow abnormally and uncontrollably, forming a mass of fluid-filled sacs that look like a cluster of grapes. There is no viable baby.

It occurs due to random genetic errors at conception is almost always curable, especially with early diagnosis and proper follow-up. It is not a type of cancer, but in rare cases, the abnormal tissue can persist and require chemotherapy.

Common Symptoms

Symptoms often resemble those of a normal early pregnancy but may become more severe or unusual.

• Vaginal Bleeding: The most common sign, usually in the first trimester. Blood may be dark brown or bright red.
• Severe Nausea and Vomiting (Hyperemesis): Much worse than typical morning sickness.
• Rapid Uterine Enlargement: Your womb may grow much faster and larger than expected for your dates.
• Pelvic Pressure or Pain.
• Passing Grape-Like Cysts: You may pass small, grape-like vesicles from the vagina.
• Early Pre-eclampsia Symptoms: Very high blood pressure, swelling, and protein in urine before 20 weeks (a serious sign).
• Hyperthyroidism Symptoms: Due to high hormone levels, you may feel anxious, have a rapid heartbeat, or experience unexplained weight loss.

A molar pregnancy is caused by an error in the fertilisation process, leading to abnormal genetic material.

There are two main types:

• Complete Molar Pregnancy: An egg with no genetic information is fertilised. The mass contains only abnormal placental tissue (no fetal tissue). It has a higher chance of persistent disease.
• Partial Molar Pregnancy: Two sperm fertilise one normal egg, resulting in three sets of chromosomes. The mass contains both abnormal placental tissue and non-viable fetal tissue.

Risk Factors:

• Maternal Age: Highest risk in teenagers and women over 35 or 40.
• Previous Molar Pregnancy: Having one increases the risk of another (about 1-2% chance).
• Dietary Factors: Possible link to low intake of beta-carotene (vitamin A) in some populations.

Diagnosis

It is often first suspected based on symptoms and an ultrasound scan.

• Transvaginal Ultrasound: The primary diagnostic tool. It shows a characteristic “snowstorm” or “cluster of grapes” appearance inside the womb, with no normal fetus.
• Blood Test (hCG measurement): The pregnancy hormone Human Chorionic Gonadotropin (hCG) is extremely high, often much higher than in a normal pregnancy at the same stage.
• Pathology Examination: After the tissue is removed, it is sent to a lab to confirm the diagnosis and type.

Treatment & Follow-up

• Initial Treatment: Removal of Tissue

• Suction Evacuation (D&C): This is the standard treatment. Under general anaesthesia, the abnormal tissue is gently suctioned out from your womb. This is a short procedure.
• Medication (Mifepristone/Misoprostol): Rarely used, only in specific circumstances.
• The Crucial Follow-Up Phase (This is Essential)
  After removal, you must enter a monitoring program. This is because in about 15% of complete and 1% of partial moles, abnormal cells can persist.

• You will have regular blood tests (every 1-2 weeks) to track your hCG level until it returns to normal and stays normal.
• This usually takes several months.
• You must use reliable contraception (usually the pill) during this entire monitoring period to prevent a new pregnancy, which would make hCG tracking impossible.
• Further Treatment (If needed)
  If your hCG levels plateau or rise, it indicates persistent trophoblastic disease. This is treatable and usually cured with:

• Chemotherapy: A short course is highly effective.
• Further Surgery: In rare cases.

Emotional Impact & Future Pregnancies

Emotional Recovery:

• A molar pregnancy is a pregnancy loss. You may feel grief, confusion, anger, or anxiety. This is normal.
• The need for prolonged monitoring can be emotionally draining.
• You should seek support from your partner, family, friends, or a counsellor.

Future Pregnancies:

• Most women can go on to have a completely healthy pregnancy in the future.
• It is recommended to wait until your hCG monitoring is successfully completed (usually 6 months to 1 year after levels normalise) before trying to conceive again.
• In future pregnancies, you will be offered an early ultrasound scan at 6-8 weeks for reassurance.

Frequently Asked Questions (FAQs)

Q: Did I do something to cause this?
A: Absolutely not. It is a random genetic accident during fertilisation. Nothing you did, ate, or thought caused this.

Q: Was it a baby?
A: In a complete molar pregnancy, there was never an embryo. In a partial molar pregnancy, the genetic abnormality is so severe that a baby could never develop. The pregnancy was never viable.

Q: Is this cancer?
A: In over 85% of cases, no and it is a benign growth. The persistent form that requires chemotherapy is often called a cancer because it can spread, but it has one of the highest cure rates of any cancer (close to 100%).

Q: Can my partner and I still have a healthy baby?
A: Yes. The genetic error happened in that specific egg or sperm at that specific time. It does not mean you or your partner have a general fertility problem.

Q: How will I know if it comes back?
A: This is the purpose of the hCG monitoring. You will not be discharged from the specialist centre until they are certain the risk is extremely low. You will be told what symptoms to watch for.

eGynaecologist Advice

• You must understand that follow-up care is not optional and must attend every scheduled blood test, as this is critical to ensure the condition is completely resolved and to detect any rare persistent disease early when it is most easily cured.
• You must use effective contraception consistently throughout the entire hCG monitoring period as advised by your specialist team. A new pregnancy will disrupt monitoring and cause significant distress.
• You will require to register with a specialist centre for Gestational Trophoblastic Disease (e.g., Charing Cross Hospital in the UK or an equivalent regional centre) to coordinate your monitoring and provide expert care.