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molar pregnancy Alternative Names
hydatiform mole, trophoblastic disease, gestational trophoblastic neoplasia
Definition
A molar pregnancy occurs when a foetus is not able to fully form in the uterus. Instead, the foetal tissue becomes a tumour.
What is going on in the body?
In Australia, a molar pregnancy occurs in 1 out of every 1400 pregnancies. In this condition, foetal cells have an abnormal genetic makeup and form a tumour. This tumor, or "mole," can grow and even spread to other parts of a mother's body. In some cases, the mole may turn into a more dangerous cancer called choriocarcinoma.
What are the signs and symptoms of the condition?
Common symptoms of this condition may include: - vaginal bleeding during pregnancy or shortly after a pregnancy, miscarriage, or abortion
- severe nausea and vomiting, often bad enough to require treatment in the hospital
- a uterus that grows slower or faster than normal during pregnancy
- symptoms from an abnormally high level of thyroid hormone, also called hyperthyroidism
- high blood pressure that begins for the first time in the first trimester. This may mean that preeclampsia, also called toxaemia of pregnancy, is present.
- symptoms of the tumour or cancer spreading to other organs. For example, coughing up blood may occur if the tumour goes to the lungs, or abdominal pain if the tumour goes to the liver.
What are the causes and risks of the condition?
In this condition, abnormal foetal tissue inside a woman's uterus forms a tumour. The exact reason this occurs is not known. Common risk factors for this condition include: - a recent full-term pregnancy, abortion, miscarriage, or ectopic pregnancy
- a previous molar pregnancy
- being of Asian descent
- being younger than 20 or older than 40 years of age
- being poor
- a diet that is low in protein, folate, or beta-carotene
What can be done to prevent the condition?
Women are advised to get enough folate, carotene, and protein in their diet before becoming pregnant. This may decrease the risk of this condition.
Early diagnosis improves the chance of cure, though it cannot prevent this condition. Any woman with abnormal vaginal bleeding or other unusual symptoms after pregnancy should see her doctor.
How is the condition diagnosed?
Diagnosis begins with a history and physical examination. There is usually a history of a recent pregnancy, whether or not a child was born. A blood test is done to measure the level of HCG, the "hormone of pregnancy." In a molar pregnancy, the level of HCG becomes too high because of the abnormal foetal tissue.
If the level of HCG is abnormally high, an ultrasound can help locate and confirm the tumour. A chest x-ray or MRI or CT scan of different parts of the body may be done if the doctor suspects that the tumour has spread to other organs.
What are the long-term effects of the condition?
I n most cases, treatment results in a cure and there are few long-term effects. However, the tumour can spread to other areas of the body, which may result in organ damage and even death.
What are the risks to others?
This condition is not contagious and poses no risk to others.
What are the treatments for the condition?
In most cases, the main treatment is a procedure called a dilation and curettage (D&C). This involves removing all the contents of the inside of the uterus with a special tool. In women who do not want any more children, a hysterectomy, or the removal of the uterus, may be advised.
If the tumour has spread to other areas of the body, chemotherapy and sometimes radiation therapy is usually advised.
What are the side effects of the treatments?
If a hysterectomy or a D&C is done, the side effects may include bleeding, infection, and scarring of the uterus. Chemotherapy can cause stomach upset, nausea, weakness, and other side effects.
What happens after treatment for the condition?
A woman is advised to take it easy for a few days after a D&C. A hysterectomy usually requires a few weeks of recovery. The woman should be alert for any unusual bleeding after surgery.
After all types of treatment, the level of HCG in the blood is checked regularly to make sure it returns to normal. If the level of HCG stays high or becomes high again in the future, this may mean that the tumour has spread or come back. Birth control should be used for at least 1 year after treatment. This is because pregnancy, by raising the level of HCG, can make it hard to detect if the tumour has come back.
How is the condition monitored?
Regular chest x-rays and pelvic examinations are often advised. Any new or worsening symptoms should be reported to the doctor.
Author: Eva Martin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Contributors
Potential conflict of interest information for reviewers available on request |
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