By Dr. Isabel Herrera (Licensed Physician No. 030310741).
A molar pregnancy, also known as a hydatidiform mole, is a rare complication of pregnancy characterized by the abnormal growth of the cells that normally develop into the placenta. This abnormal growth forms a mass or benign tumor in the uterus.
There are two types: benign and malignant (also known as choriocarcinoma). The benign type can be either complete or partial:
In this type, no fetal tissue is present. It occurs when an egg is fertilized by a sperm that duplicates its genetic material, resulting in a set of chromosomes entirely from the father. There is no maternal genetic material.
In this case, there may be abnormal fetal tissue along with the abnormal placenta. It usually happens when two sperm fertilize a single egg, leading to an excess of genetic material.
These pregnancies are caused by genetic abnormalities during the fertilization of the egg, which leads to the abnormal growth of placental tissue instead of a viable fetus.
A complete molar pregnancy occurs when a sperm fertilizes an egg without genetic material and duplicates its chromosomes, or in some cases, when two sperm with the same paternal DNA fertilize the egg. As a result, the embryo does not develop, and only abnormal placental tissue grows.
In a partial molar pregnancy, a normal egg is fertilized by two sperm instead of one, producing an embryo with an abnormal number of chromosomes (69 instead of 46, known as triploidy). Although an embryo may form, it usually has severe abnormalities and cannot survive.
A partial molar pregnancy can result in a live birth. Although rare, there have been cases where a healthy fetus coexists with a partial mole. However, these pregnancies carry a high risk of complications for both the mother and the fetus, such as preeclampsia and intrauterine growth restriction.
A characteristic ultrasound sign is the "snowstorm" appearance in the ovaries. Respiratory failure may also occur.
Some women are more likely to develop a molar pregnancy, depending on various factors:
If you have further questions or a history of molar pregnancy, it is best to consult a specialist for guidance and proper follow-up.
Symptoms of a molar pregnancy may resemble those of a normal pregnancy at first but become more abnormal over time. Some of the most common signs include abnormal vaginal bleeding (which may be dark brown), severe nausea and vomiting, or rapid uterine growth (faster than expected for gestational age).
In these pregnancies, there may also be absence of fetal heartbeat, high blood pressure and early preeclampsia, ovarian cysts, and enlarged ovaries due to elevated hCG levels and hyperthyroidism.
A molar pregnancy is usually detected in the first trimester, typically between weeks 8 and 14 of gestation. An early ultrasound may show the absence of an embryo in a complete mole or severe abnormalities in a partial mole.
The hormone human chorionic gonadotropin (hCG) may also indicate a molar pregnancy. In these cases, hCG levels are much higher than normal for the gestational age, which can cause intense symptoms like severe nausea and vomiting. Additionally, faster-than-expected uterine growth or abnormal vaginal bleeding may alert the doctor.
Often, a molar pregnancy is detected during the first routine ultrasound, even before the woman experiences symptoms. That’s why early prenatal checkups are important.
Treatment for a molar pregnancy generally involves removing the molar tissue from the uterus, and the pregnancy must be terminated. It is necessary to completely remove the abnormal tissue to prevent complications. The most commonly used treatment is uterine curettage.
In rare cases, a hysterectomy may be performed if there is a higher risk of developing gestational trophoblastic neoplasia and the patient does not wish to have future pregnancies.
After treatment, weekly hCG monitoring is done until levels return to normal, and follow-up continues for 6 months to a year to ensure there is no recurrence. In some cases, periodic ultrasounds and chest X-rays are required, and contraception is usually recommended to avoid pregnancy during the follow-up period.
In severe cases of choriocarcinoma, treatment involves removal of all tissue, including the uterus, and chemotherapy.
In most cases, after a molar pregnancy, a woman can have a normal pregnancy in the future, and fertility is not affected.
However, there are some risks and considerations. A woman who has had a molar pregnancy has a 1% to 2% chance of having another in future pregnancies. If she has had two previous molar pregnancies, the risk increases to about 10–15%.
It is recommended to wait 6 months to 1 year before trying to conceive again, as this allows time to ensure that hCG levels have returned to normal and that there is no persistent trophoblastic disease.
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