Molar Pregnancy

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Topic Overview

What is a molar pregnancy?

A molar pregnancy is a mass of abnormal tissue (hydatidiform mole) that comes from the placenta inside the uterus, which triggers symptoms of pregnancy. About 1 out of 1,000 women with early pregnancy symptoms has a molar pregnancy.¹

There are two types of molar pregnancy: complete and partial.

• Complete molar pregnancy. In place of a normal placenta and embryo, the hydatidiform mole is abnormal placental tissue that grows into a grapelike cluster that can fill the uterus.
• Partial molar pregnancy. The placenta grows abnormally into molar tissue. Any fetal tissue that develops is likely to have severe defects.

In extremely rare cases, an apparent twin pregnancy is found to be one complete mole and one normal, healthy placenta and fetus.²

What kind of risks are related to a molar pregnancy?

A hydatidiform mole can cause excessive bleeding from the uterus.

A small percentage of molar pregnancies lead to abnormal cell growth called gestational trophoblastic disease.

• About 15% to 20% of complete molar pregnancies develop trophoblastic disease. A small percentage of these may become invasive cancer.^{3, 4} Fortunately, nearly 100% of those women who develop cancer are cured with treatment.¹
• About 5% of partial molar pregnancies develop trophoblastic disease.⁴

In rare cases, the abnormal tissue can spread (metastasize) to other parts of the body.

What causes a molar pregnancy?

Molar pregnancy is thought to be caused by a problem with the genetic information of an egg or sperm. A molar pregnancy can develop during the earliest stage of a pregnancy when:

• An abnormal egg with no genetic information is fertilized by a sperm. The sperm's chromosomes duplicate and develop into a complete mole.
• A normal egg is fertilized by two sperm. This cell mass is most likely to develop into a partial mole.

Factors that may increase your risk of having a molar pregnancy include:

• Age. Risk for complete molar pregnancy steadily increases after age 35.⁵
• History of molar pregnancy, particularly if you've had two or more.⁴
• History of miscarriage.
• A diet low in carotene (a form of vitamin A). Women with low carotene or vitamin A intake have a higher rate of complete molar pregnancy.⁵

What are common symptoms of a molar pregnancy?

A molar pregnancy triggers the same first-trimester symptoms that a normal pregnancy does (a missed menstrual period, breast tenderness, fatigue, increased urination, morning sickness). It may be diagnosed during an early ultrasound test. In addition to normal pregnancy signs, a molar pregnancy usually causes additional symptoms, which can include:

• Vaginal discharge of grapelike tissue. This is the most characteristic symptom of a molar pregnancy.
• Vaginal bleeding (light or heavy).
• A uterus that is abnormally large for the length of the pregnancy.
• Severe nausea and vomiting.
• Signs of hyperthyroidism, such as fatigue, weight loss, increased heart rate, heat intolerance, sweating, irritability, anxiety, muscle weakness, and thyroid enlargement.

Most of these symptoms can develop along with other conditions, such as a multiple pregnancy, a miscarriage, or even a healthy pregnancy.

How is a molar pregnancy diagnosed?

If you have symptoms that suggest a molar pregnancy, your health professional will do some simple tests. A pelvic exam, a blood test of your pregnancy hormone (human chorionic gonadotropin, or hCG) levels, and a pelvic ultrasound can confirm whether you have a molar pregnancy.

Molar pregnancy may also be found during a routine ultrasound in early pregnancy.

How is a molar pregnancy treated?

If you are diagnosed with a molar pregnancy, you will need immediate treatment to remove all molar growth from your uterus. After your uterus is cleared of molar tissue, you will have periodic hCG blood tests to screen for signs of persistent cell growth (trophoblastic disease) in your uterus. These tests are done periodically for 6 to 12 months.

In some cases, trophoblastic disease can develop into trophoblastic cancer. However, most cases are identified early, located in the uterus only, and are highly curable with chemotherapy. In the rare case when cancer has had time to spread to another part of the body, more aggressive chemotherapy is necessary, sometimes combined with radiation treatment.

Most women who have been treated for trophoblastic disease are still able to become pregnant.⁶

After having a molar pregnancy, it is common to feel grief over losing a pregnancy and be fearful about cancer risk. Consider contacting a support group or talking to friends, a counselor, or religious advisor to help you and your family deal with this difficult time.

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Last updated:	November 03, 2005
Author:	Colleen Cronin
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, Kirtly Jones, MD - Obstetrics and Gynecology
Editors:	Susan Van Houten, RN, BSN, MBA, Lisa Shaw