Molar pregnancy is a type of abnormal pregnancy popularly known as " hydatidiform mole " .This disease, encountered during early stage of pregnancy, in which healthy development of the production of pregnancy fails is aserious, life threatening condition which should not be overlooked. In fact it is the abnormal development of the placenta which is known as the partner of the baby and it is characterized with containing plenty amount of structures in grape form inside the uterus.
Molar pregnancy is divided into two: Complete (full) and partial (incomplete or partial):
Complete (full) Mol:
Pregnancy is only composed of placental tissues. There are no tissues belonging to the baby. This condition is the result of fertilization of an empty ovum not having nucleus and chromosomes by the sperm. infant development doesn’t occur due to the absence of the nucleus but placenta continues to evolve. The patient has symptoms of pregnancy due to the BHCG hormone secreted from the placental structures. This is the most frequently observed form of molar pregnancy. The symptoms appear in early stages of pregnancy.
In addition to the abnormal placental development in complete mol, structures belonging to the baby are also present inside the uterus. It is caused by fertilization of the ovum with 2 sperms. The baby with genetically extra chromosome, has no chance of survival. When the two sperms (23+23=46) enter inside and combine with female chromosomes (23), a pregnancy material having 69 chromosomes which is a genetic code disorder evolves.
Incidence increases with the increasing maternal age.
more common in women with low socioeconomic status and poor nutrition
The incidence is reported to be 1 in 1000 pregnancies. The risk of mole pregnancy in those who experienced molar pregnancy previously, increases up to 10 times and rises to 1% .
The risk increases up to 10% in those who had mol pregnancy twice .
All the symptoms of pregnancy may be found in the patients. Delay in menstruation is the first finding. Pregnancy test results will be positive. Molar pregnancy usually causes bleeding during early period of pregnancy and the patient usually applies believing that it is a miscarriage. Nausea and vomiting related to pregnancy are more severe. Because the amount of BHCG secreted in these diseases is significantly higher than normal. Rarely, situations such as preeclampsia (pregnancy toxicity), hyperthyroidism , excessive hair growth caused by the secretion of other hormones may appear in the early stages.
Some of the pregnant women present complaints like dropping pieces like grapes.
in some patients, cystic structure may be detected in both ovaries due to elevation of BhCG (a hormone released from the placenta, pregnancy test hormone). Symptoms such as pain and hair growth in the body may be added if these cysts grow and release hormone.
All symptoms are usually less severe and gives evidence at a later stage in partial moles.
Before the treatment, blood tests are done, blood group is determined, spread to other organs is examined. Chest x-ray is performed. The main treatment in this disease, is emptying inside of the uterus which means the termination of pregnancy following to dilating the cervix under general anesthesia in the hospital
Molar pregnancy, can turn into a disease called trophoblastic neoplasia (GTN). Whereas Molar pregnancy is a condition that only involves the uterus and not spreads to other organs, GTN is a bad disease which can spread to the other parts of the body (metastasis) or recur inside the uterus.
Patients were followed closely because of the risk of recurrence of molar pregnancy. Patients should not get pregnant for 1 year during follow up program. Birth control pills are ideal for this purpose. Initially, BHCG is measured weekly until the levels return to normal.
(Follow-up should be continued until BHCG level reduces to zero in three consecutive weeks of follow up ). Chest X-Ray is performed. After weekly follow ups, monthly follow ups are done for 6 months and afterwards 2-mobths BHCG follow up is done.
The case is evaluated in terms of recurrence with gynecologic examination once every 3 months, ultrasound and blood tests. If everything is normal at the end of one year, getting pregnant is allowed.
Whole body is examined in terms of metastasis (spread) with various imaging modalities. The treatment is initiated with variety pf chemotherapy methods depending on the prevalence and severity of the disease. Good results can be obtained with favorable responses to the chemotherapy.