Molar PregnancyTo the pregnant women reading this, let us begin by saying that molar pregnancies are relatively rare. It happens in 1 out of every 1,000 pregnancies.1 Statistically speaking, an overwhelming majority of pregnancies are uncomplicated and result in healthy births.2 So what is a molar pregnancy? A molar pregnancy, also referred to as hydatidiform mole, occurs as early as fertilisation. A defect in the trophoblasts or the cells that are supposed to develop into the placenta, causes it to develop into an abnormal mass or a tumor instead. These masses or tumors appear as water-filled sacs in grape-like clusters.3 A molar pregnancy falls under a group of conditions called Gestational Trophoblastic Disease or GTD. Aside from molar pregnancies, GTD covers other diseases that involve rare tumors that form inside a woman’s uterus from the cells that would have otherwise developed into the placenta.4 There are two types of molar pregnancies: complete and partial.
Complete Molar PregnancyA molar pregnancy is considered complete when no foetal tissue develops in the womb. This happens when the sperm ends up fertilising an empty egg. Therefore, only molar tissues develop. This is the more common type.
Partial Molar PregnancyIn a partial molar pregnancy, an incomplete embryo and placenta may develop along with the molar tissues. This happens when a normal egg is fertilised by two (instead of the usual one) sperm, resulting in a non-viable embryo. Partial molar pregnancy is even rarer than complete molar pregnancy.
- Dark brown to bright red spotting or bleeding
- Severe nausea and vomiting
- Early preeclampsia
- Pelvic pressure or pain
- Rapid uterine growth
- Vaginal passage of grape-like cysts
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CausesMolar pregnancies are caused by the abnormal fertilisation of the egg resulting in an abnormal fetus. Instead of fetal tissue, the placental tissue forms a mass in the uterus instead. This phenomenon can be narrowed down to chromosomal (genetic material) imbalance in the pregnancy. This happens when an egg, which doesn’t contain genetic information, fertilise with a sperm, or when a normal egg is fertilised by two sperm. Read also : Gestational Diabetes Mellitus: Why It is No Sweet Talk
Detection and DiagnosisMost molar pregnancies are discovered only when a miscarriage occurs, but it can also be detected through a transvaginal ultrasound as early as eight to nine weeks of pregnancy. A complete molar pregnancy may reveal:
- The absence of an embryo
- The absence of amniotic fluid
- Thick molar tissues in the uterus
- A growth-restricted embryo
- Low amniotic fluid
- Thick molar tissues in the uterus
Risk FactorsAlthough it is generally rare, certain factors increase the likelihood of developing a molar pregnancy. The women who are more at risk are typically:
- Over 35 years old or under 20 years old
- With a history of previous molar pregnancy
- With a history of miscarriage
- Of Asian ethnicity
- Women from Southeast Asia and Korea have a slightly increased risk for a molar pregnancy. There have been some dietary theories proposed about why this may be the case.5
Treatment, Management, and PreventionThe typical treatment for molar pregnancies begin with removing the non-viable embryo and placenta from the uterus through vacuum suction (evacuation of uterus) procedure. The molar tissue will then be examined to confirm the molar pregnancy diagnosis. After an evacuation, for the next six months to a year, her HCG levels will be regularly checked through blood tests. HCG is a hormone produced during pregnancy. If the HCG levels remain high after the evacuation procedure, it could mean than some molar tissue remains or has grown back in the uterus. This is the reason why women who go through molar pregnancy are advised to wait until after a year before trying to conceive again. It’s impossible to tell if the increased hCG levels in the blood is a result of a new pregnancy or because of the presence of molar tissue. If molar tissue remains and continues to grow in the uterus after it has been surgically removed, it has developed into gestational trophoblastic neoplasia, a rare form of cancer. The risk of this developing is 15% in a complete mole and 0.5% in a partial mole. The doctor may recommend additional treatment, such as chemotherapy or medication. In very rare cases, this could progress to choriocarcinoma, a form of cancer that can spread to the other parts of the body. Whether you’re pregnant or not, planning to get pregnant or considering contraceptives, see your Gynaecologist regularly to properly monitor your reproductive health. Book a consultation with Dr. Pamela Tan today.
Endnotes1. https://americanpregnancy.org/pregnancy-complications/molar-pregnancy/ 2. https://www.medicalnewstoday.com/articles/322634.php 3. https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175 4. https://www.cancer.org/cancer/gestational-trophoblastic-disease/about/what-is-gtd.html 5. https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1046/j.1471-0528.2003.01413.x
Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.