A molar pregnancy is one of the serious complications of pregnancy. It happens when something goes wrong during the fertilization process at conception. In a molar pregnancy, the early placenta develops into a fast-growing mass of cysts (hydatidiform mole) in the uterus. It occurs in about 0.5to 1% of the pregnant woman.
Figure 1: Molar pregnancy looking like cluster of grapes.
Complete molar pregnancy: In this pregnancy, the fertilized egg has no maternal chromosomes and the chromosomes from the father’s sperm are duplicated, so there will be two copies of chromosomes from the father and none from the mother. Complete molar pregnancies have only placental parts, and form when the sperm fertilizes an empty egg. Because the egg is empty, no baby is formed. The placenta grows and produces the pregnancy hormone, called HCG, so the patient thinks she is pregnant. Instead, the placenta forms a mass of cysts that looks like a cluster of grapes.
Figure 3: Complete molar pregnancy with 46 chromosomes, two copies of chromosomes from the father and none from the mother.
Partial molar pregnancies: In most partial molar pregnancies, the fertilized egg has the normal complement of chromosomes from the mother but double the chromosomes from the father, so there are 69 chromosomes instead of the normal 46. In this case, there’s some placental tissue among the cluster-like mass of abnormal tissue. The embryo does begin to develop, so there may be a fetus, or some fetal tissue, or an amniotic sac. The baby has too many chromosomes and almost always dies in the uterus.
Figure 4: partial molar pregnancy with 69 chromosomes, normal complement of chromosomes from the mother but double the chromosomes from the ಫಾಥೆರ್
Risk factors: Unfortunately, any woman, no matter what her age, race or medical background, can develop a molar pregnancy. However, it is more common in women over the age of 40. It is common in women having a previous molar pregnancy or miscarriage or ectopic pregnancy. It is also common in women suffering in vitamin A deficiency.
Signs and Symptoms: Symptoms include: A molar pregnancy typically triggers common signs of pregnancy—a missed menstrual period, breast tenderness, fatigue, weight loss, increased heart rate, heat tolerance, sweating, irritability, anxiety, muscle weakness, increased urination, and morning sickness. Signs of pregnancy that may develop any of the following during first trimester:
Vaginal discharge of tissue that is shaped like grapes.
Severe nausea and vomiting
High blood pressure,
A uterus that is abnormally large for the length of the pregnancy.
Levels of the pregnancy hormone human chorionic gonadotrophin (hCG) will be much higher than normal.
Diagnosis: Ultrasound scanning will detect molar pregnancy very easily. In the scanning the pregnancy looks like “cluster of graphes”. No fetus will be detected.
Complications: If the molar pregnancy not removed completely it may continue to grow inside. It may cause vaginal bleeding. Sometimes, it may become cancer also.
Treatment: A molar pregnancy is removed with vacuum aspiration D & C (dilation and curettage) under general anesthesia. There are high risk of developing cancer after a molar pregnancy and can be treated with methotrexate or Dactinomycin.
Precautions: Pregnancy following too soon after molar pregnancy may also increase the risk of recurrence or re-activation of the mole. Avoid pregnancy for at least six months with normal urine hCG levels or until your consultant gives you the go ahead.
Conclusion: Experiencing a molar pregnancy is extremely stressful for the woman, her partner and family. Not many people understand the physiology of such a pregnancy. It is generally best to tell loved ones that a miscarriage has occurred and that special follow up lab work is necessary. When the pregnancy itself has been “ambiguous” and the life of the mother has been at risk, it may be harder to understand and disclose all of the details.
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