Molar_Pregnancy

Molar Pregnancy. A molar pregnancy which is medically known as a Hydatidiform mole is an abnormality of the placenta which is caused when the sperm fertilizes an egg without a nucleus. A baby is not always present and the cells that line the gestational sac begin to convert into a growth resembling a cluster of watery grapes, thus signifying an abnormal placenta. Hydatid literally means a watery cyst. There are two types of molar pregnancy, complete and partial. A complete molar pregnancy occurs when a sperm fertilizes an empty egg with no nucleus and only the placenta is formed. As the placenta grows the pregnancy hormone HCG is produced making the mother believe that she is pregnant with a healthy baby. An ultrasound will show only a placenta. No baby will grow. Normally a developing babies chromosomes are made up of half from the mother and half from the father. In the case of a complete molar pregnancy the fertilized eggs chromosomes come from the father. Shortly after fertilization has taken place the chromosomes from the mother’s egg are inactivated and the father’s chromosomes are duplicated. A partial molar pregnancy occurs when an egg is fertilized by two sperm. Instead of forming twins, an abnormal fetus and abnormal placenta will develop. As the baby has too many chromosomes it normally always dies within the womb and is consumed very quickly by the developing mass. In the case of a partial molar pregnancy the mother’s 23 chromosomes still exist but there are two sets from the father resulting in the embryo having 69 chromosomes instead of 46. About 1 in every 1000 women has a molar pregnancy. The risks of developing a molar pregnancy are higher if the mother is under 20 years of age or over 40 years of age and if the mother has had two or more miscarriages. If a molar pregnancy has been experienced in the past the chances of another one occurring is about 1-2%. A molar pregnancy will present the same symptoms as a normal pregnancy during the first trimester such as fatigue, tender breasts, nausea and vomiting and a missed period. Many molar pregnancies appear completely normal and nothing would make the mother suspicious of anything being wrong. Bleeding can start as early as 6 weeks and as late as 16 weeks. Along with these symptoms one way of recognising molar pregnancies are; • vaginal bleeding during the first trimester • discharge of tissue that looks like the shape of a cluster of grapes • enlarged ovaries that are detected by an ultrasound • a uterus that grows too quickly • High levels of HCG which is detected though a blood test • Severe nausea, vomiting and high blood pressure • signs of hyperthyroidism such as weight loss, increased heart rate, sweating, heat intolerance, muscle weakness and thyroid enlargement Paula Sinclair, from Swansea, started bleeding when she was nine weeks pregnant. When she was taken to hospital for a scan she was told that she had a partial molar pregnancy. “I was totally shocked. I’d never even heard of such a thing and the thought of getting cancer from being pregnant was completely frightening. I had an emergency D&C the same afternoon as my scan. The following day I was given another scan and an x-ray and was told that all of the pregnancy tissue had been removed, that I would be fine and wouldn’t need any other treatment. I was so relieved. I still had to have check-ups with my GP and was told not to get pregnant within a year. Although I’d lost my baby, which took along time to recover from, I was glad I had my health”. Molar pregnancies can be diagnosed in several ways; by pelvic exam which will reveal a larger or smaller than usual uterus and enlarged ovaries which are caused by the non-cancerous cysts from abnormally high levels of HCG. Blood is tested for increased or decreased levels of HCG. If the pregnancy is a complete mole then the HCG levels would be much higher than a normal pregnancy and if it is a partial mole then the HCG levels would be much lower than normal. An ultrasound can also detect a molar pregnancy and the cluster of grape like cysts would be clearly visible. If a molar pregnancy is not suspected then it may proliferate until the woman has her routine ultrasound. With the appropriate treatment nearly all molar pregnancies are curable. If a woman is diagnosed as having a molar pregnancy then it is treated as a medical emergency. A molar pregnancy can be very frightening as well as worrying, not only does the woman have the pain of losing a baby but her health can be in jeopardy. Molar pregnancies are usually quite harmless but if left untreated then they can become cancerous. If it is not treated then the cysts continue to grow and bury themselves in surrounding organs which can then spread though the bloodstream to other parts of the body such as the lungs, brain, kidneys, liver and spleen. With the correct treatment it is curable and even cases that have a poor prognosis can be cured with a combination of surgery and chemotherapy. A D&C is usually carried out and all tissue is removed from the uterus. If the woman does not want anymore children then in some instances a hysterectomy maybe carried out to ensure that the woman does not develop gestational trophoblastic disease. After the D&C it is usual for the woman to have a chest x-ray to ensure that no abnormal cells from the mole have spread to the lungs which is the most common site of spreading. After the D&C and x-ray it is paramount that the woman continues to see her GP for follow up treatment as cancerous cells can reoccur. Anyone who is RH negative will be given a rhogam shot. It is normal to have physical examinations of the vagina and uterus every two weeks until it returns to normal size and then every three months for one year. Patients are also advised not to get pregnant for one year as HCG levels need to be monitored weekly until they fall to zero and then every month for one year, to ensure that the cancerous cells have not come back. When HCG levels drop and then increase it means that the molar pregnancy has grown from microscopic cells to larger cells. If the woman fell pregnant then HCG levels would automatically increase and it would be hard to tell if the increase was due to the pregnancy of because of the original molar pregnancy reoccurring. Brenda Mithey, from Cardiff, had a complete molar pregnancy and had to have a D&C to remove the growth, followed by chemotherapy to kill off any remaining cancerous cells. “I thought I was pregnant with a baby and at my 12 week scan I was shown a group of cells that looked just like a bunch of grapes. I was told that there was no baby and never had been. That’s the day the nightmare began. I ended up having a D&C and as some of the tissue was left behind I ended up having chemotherapy to treat any cells that had spread. I was told not to get pregnant for at least a year and had to have monthly check-ups with my doctor for a year. I’d lost my dream of a baby and what I saw just looked alien. After two and a half years I am now pregnant again and have had scans which have shown a perfect looking baby. It has been a very frightening journey”. Gestational trophoblastic disease develops when part of the mole remains in the uterus after treatment and chemotherapy is usually needed to eradicate it as the cells can spread to other parts of the body like cancer. This only occurs in about 20% of complete molar pregnancies and about 2% in partial molar pregnancies. With chemotherapy there is a very high success rate of treating the cancerous cells and many women go on to have normal, straightforward pregnancies. In any subsequent pregnancy then an ultrasound is given to ensure that everything is ok. It is a very rare cancer called choricarcinoma occurring in about 1 in every 40’000 pregnancies and is curable. When chemotherapy is administered it is usually as in intramuscular injection and the medication used is Methotrexate. In some cases only one shot may be required, however, in more severe cases where the cancerous cells have spreads to other parts of the body more than one shot is needed along with other medication A molar pregnancy does not affect future fertility and will not increase any risks of having a still birth, birth defects or complications with delivery. It takes a long time to recover from a molar pregnancy as not only does the woman lose the baby that she thought she was carrying along with all the dreams of having a baby, she also needs to contend with health issues. To begin with the woman may only worry about her own health and will cry for the baby once she is better. Along with the emotional pain attached to the loss of a molar pregnancy it is also advised to put off trying to conceive for another baby for a considerable amount of time after, thus prolonging the pain. Support Groups- MyMolarPregnancy.com Web- www.mymolarpregnancy.com Information, links, references and support groups for anyone who has suffered a molar pregnancy. Hydatidiform Mole and Choriocarcinoma UK Information and Support Service Web- www.hmole-chorio.org.uk Email- hmole-chorio@hhnt.nhs.uk Tel- 020 8846 1409 Information and support for anyone who has suffered a molar pregnancy. Miscarriage Association Web- www.miscarriageassociation.org.uk Email- info@miscarriageassociation.org.uk Tel- 01924 200799 Information and support for anyone who has suffered a miscarriage of any kind including molar pregnancy. Babyloss Web- www.babyloss.com Email- support@babyloss.com Information and support online for anyone affected by the death of a baby at any stage of pregnancy.