What is a molar pregnancy?

So what is a molar pregnancy?

In the case of normal pregnancy, if an egg from the female is fertilized by a sperm from the male. This results in the formation of an embryo which in turn will develop into a fetus.

Molar pregnancy is also known as a hydatidiform mole; it is a very rare condition that occurs in less than 1 in 700 pregnancies; the truth is that many people have never even heard of it, including some doctors! The term ‘hydatidiform mole’ literally means a fluid-filled mass of cells; the word mole means ‘a mass of cells’ and hydatid means ‘containing fluid-filled sacs or cysts’.

Effectively there is an imbalance in the number of chromosomes supplied by the mother and the father and so the fertilized egg cannot develop as it does not have the correct genetic information.

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Types of molar pregnancy

There are two forms of molar pregnancy:

Partial molar pregnancy - if two sperm fertilize the egg instead of one a partial molar pregnancy results. In this case, the embryo cannot develop due to there being too much genetic material
Complete molar pregnancy - if an egg which does not contain any genetic material (in effect is ‘empty) is fertilized by one sperm or even two sperm, there are not enough of the right type of chromosomes present for the pregnancy to develop

In very rare cases the molar cells will embed deeply into the wall of the uterus; in turn, these cells can become cancerous. This is called an invasive mole and if it remains untreated it can lead to choriocarcinoma which is an invasive form. Fortunately, it has a cure rate of almost 100%

Causes of molar pregnancy

The reason for molar pregnancy is quite simply the lack of correct genetic material being present in order for the pregnancy to result in a healthy human being.

There is nothing to ‘cause’ a molar pregnancy, but molar pregnancy may be more likely to occur if one of the following applies:

You have had a molar pregnancy previously
You have an Asian background
If you are a young teenager or are older than 45 years when you become pregnant

Symptoms of molar pregnancy

It is not unusual for a pregnant woman not to experience any symptoms associated with molar pregnancy and they will be diagnosed when they have an ultrasound scan during the pregnancy. Some women however may have symptoms which might include:

A strongly positive pregnancy test with a missed period
More nausea and vomiting than would be expected
‘Spotting’ or breakthrough bleeding from the vagina
Other symptoms similar to those that may be experienced during a miscarriage

Diagnosis of a molar pregnancy

A woman may discover that she has a molar scan at her first pregnancy ultrasound scan and sometimes it is not until a pregnant woman has a miscarriage that the condition is discovered. Diagnosis of a molar pregnancy can be very difficult but seek advice from a doctor or midwife if you suspect that something is not right because you experience one of the following:

You have bleeding or dark discharge from the vagina
You are experiencing severe morning sickness
You feel that your pregnancy swelling is particularly large when considering the stage of your pregnancy
You have any other symptoms you are worried about

If your midwife or doctor feels that there is a possibility of your pregnancy being a molar pregnancy, they will check using the following tests:

An ultrasound scan
Ask for a blood test to check the levels of hCG (human chorionic gonadotropin). This is a pregnancy hormone and if a molar pregnancy exists, the levels of this hormone will be elevated
They will refer you to a gynecologist or will send you to an early pregnancy assessment unit.

Treatment for a molar pregnancy

A molar pregnancy cannot survive as it does not have the correct genetic information to develop into a functioning human being. The condition may resolve itself by ending in miscarriage although surgery will be required to ensure that there is no pregnancy tissue remaining. Alternatively, if this does not happen then it will be necessary to undergo a procedure which will remove the pregnancy

What is there for you after diagnosis and treatment?

The psychological and emotional effects which will most likely be experienced following molar pregnancy may be extremely distressing. Some emotions that are commonly experienced include:

Learning that you have had a molar pregnancy which is likely something you have never heard of may leave you feeling shocked and confused.
As you learn more about the mechanics and reasons for molar pregnancy, it is probable that you will feel fear and anxiety when you realize that there is a possibility that you may develop cancer. Concern about what the future holds and future pregnancies will likely cause you to feel frightened and anxious also
In coming to terms with the loss of your baby you will feel loss and grief
The medical profession will advise that you wait before trying again and this may leave you feeling at a loss and in limbo
As discussed earlier, molar pregnancy is extremely rare and the fact that your friends and family may not have heard of it and have no understanding of it may leave you feeling isolated and alone

Finding support after a molar pregnancy

If you have experienced a miscarriage, this alone leaves you with a sense of loss and associated grief but then the additional news that it was a molar pregnancy that could never have survived will add another layer to the distress.

There is help out there with the following organizations:

Molar Pregnancy - Support and Information

http://molarpregnancy.co.uk/

Molar Pregnancy

https://www.miscarriageassociation.org.uk/information/molar-pregnancy/

What happens next?

There is aftercare which needs to be carried out after experiencing molar pregnancy. Whilst trying to cope with the emotional issues you are facing, there are some medical issues that must be addressed.

If you have had a molar pregnancy, checks are necessary to ensure that the levels of hCG have returned to normal. Follow-ups are carried out at the three specialist centers located in London, Sheffield, and Dundee. Fortunately, samples of blood and urine can be taken locally and posted to one of the centers. Levels are checked every two weeks using blood or urine samples and it is usual for levels to drop quickly

If the mole was complete and the hCG level returned to normal within 8 weeks then follow-ups will continue for 6 months after the date of surgery. If it takes longer for the levels to return to normal then follow-ups will be for 6 months after the first normal result
In the case of a partial mole, follow-ups will be carried out for four weeks after the hCG levels return to normal. If the level does not return to normal or begins to rise then more investigation and treatment will be necessary
If the mole is invasive, chances of which are incredibly small, then medical staff at the follow-up centers will be able to advise about further treatment

Future pregnancy

Fertility is totally unaffected by having a molar pregnancy. It is possible although highly unlikely that a woman will have another molar pregnancy and the chances of this happening are around 1%.

Your doctor will advise you to use contraception during the follow-up period and this may be very frustrating, but when this period is over you will be able to carry on to have a normal and successful pregnancy.