Diagnosis

If your doctor suspects a molar pregnancy, he or she will order blood tests, including one to measure the level of human chorionic gonadotropin (HCG) — a pregnancy hormone — in your blood. He or she will also recommend an ultrasound.

With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal and pelvic area. During early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface, so the ultrasound may be done through a wandlike device placed in your vagina.

An ultrasound of a complete molar pregnancy — which can be detected as early as eight or nine weeks of pregnancy — may show:

  • No embryo or fetus
  • No amniotic fluid
  • A thick cystic placenta nearly filling the uterus
  • Ovarian cysts

An ultrasound of a partial molar pregnancy may show:

  • A growth-restricted fetus
  • Low amniotic fluid
  • A thick cystic placenta

If your health care provider detects a molar pregnancy, he or she may check for other medical problems, including:

  • Preeclampsia
  • Hyperthyroidism
  • Anemia

Treatment

A molar pregnancy can't continue as a normal viable pregnancy. To prevent complications, the abnormal placental tissue must be removed. Treatment usually consists of one or more of the following steps:

  • Dilation and curettage (D&C). To treat a molar pregnancy, your doctor will remove the molar tissue from your uterus with a procedure called dilation and curettage (D&C). A D&C is usually done as an outpatient procedure in a hospital.

    During the procedure, you'll receive a local or general anesthetic and be positioned on the operating room table on your back with your legs in stirrups. Your doctor will insert a speculum into your vagina, as in a pelvic exam, to see your cervix. He or she will then dilate your cervix and remove uterine tissue with a vacuum device.

  • Hysterectomy. Rarely, if there is increased risk of gestational trophoblastic neoplasia (GTN) and there's no desire for future pregnancies, the uterus may be removed (hysterectomy).
  • HCG monitoring. After the molar tissue is removed, your doctor will repeat measurements of your HCG level until it returns to normal. If you continue to have HCG in your blood, you may need additional treatment.

    Once treatment for the molar pregnancy is complete, your doctor may continue to monitor your HCG levels for six months to one year to make sure there's no remaining molar tissue.

    Because pregnancy HCG levels also increase during a normal pregnancy, your doctor may recommend you wait six to 12 months before trying to become pregnant again. Your provider will recommend a reliable form of birth control during this time.

Coping and support

Losing a pregnancy is devastating. Give yourself time to grieve. Talk about your feelings and allow yourself to experience them fully. Turn to your partner, family and friends for support. If you're having trouble handling your emotions, consult your pregnancy care provider or a counselor.

Preparing for your appointment

You're likely to start by talking with your family doctor or pregnancy care provider. Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do

Before your appointment:

  • Write down any symptoms you're experiencing, including when they first started and how they've changed over time.
  • Make a note of the date of your last menstrual period, if you remember it.
  • Write down key personal information, including any other medical conditions for which you're being treated.
  • Make a list of all medications, as well as any vitamins or supplements you're taking.
  • Ask a friend or family member to accompany you, if possible, to your appointment. Having someone else there may help you remember something that you forgot or missed and may provide much-needed emotional support.
  • Write down questions to ask your doctor.

Preparing a list of questions in advance will help you make the most of your time with your doctor. For molar pregnancy, some basic questions to ask include:

  • What is likely causing my symptoms or condition?
  • What kind of tests do I need?
  • What needs to be done now?
  • What treatment approach do you recommend?
  • Do I need to follow any restrictions?
  • What emergency signs and symptoms should I watch for at home?
  • What are my chances for a successful future pregnancy?
  • How long should I wait before trying to become pregnant again?
  • Does my condition increase my risk of developing cancer in the future?
  • Do you have any brochures or printed material that I can take with me? What websites do you recommend for more information?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment if you don't understand something.

What to expect from your doctor

Your doctor will likely perform a physical exam and run some tests, including a blood test and ultrasound exam. He or she may also ask you a number of questions, such as:

  • When was your last menstrual period?
  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • Are you having any pain?
  • Compared with your heaviest days of menstrual flow, is your bleeding more, less or about the same? Have you passed any grapelike cysts from your vagina?
  • Are you experiencing any lightheadedness or dizziness?
  • Have you had a past molar pregnancy?
  • What chronic conditions, if any, do you have?
  • Do you wish to become pregnant in the future?
Dec. 14, 2017
References
  1. Ferri FF. Molar pregnancy. In: Ferri's Clinical Advisor 2018. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Sept. 8, 2017.
  2. Rumack CM, et al., eds. The first trimester. In: Diagnostic Ultrasound. 5th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Sept. 8, 2017.
  3. Walls RM, et al., eds. Acute complications of pregnancy. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Sept. 8, 2017.
  4. Berkowitz RS, et al. Hydatidiform mole: Epidemiology, clinical features, and diagnosis. https://www.uptodate.com/contents/search. Accessed Sept. 8, 2017.
  5. Gockley AA, et al. The effect of adolescence and advanced maternal age on the incidence of complete and partial molar pregnancy. Gynecologic Oncology. 2016;140:470.
  6. What is gestational trophoblastic disease? American Cancer Society. https://www.cancer.org/cancer/gestational-trophoblastic-disease.html. Accessed Sept. 9, 2017.
  7. Berkowitz RS, et al. Hydatidiform mole: Management. https://www.uptodate.com/contents/search. Accessed Sept. 8, 2017.
  8. Diagnosis and treatment of gestational trophoblastic disease. Rockville, Md.: Agency for Healthcare Research and Quality. https://www.guideline.gov/summaries/summary/10938/diagnosis-and-treatment-of-gestational-trophoblastic-disease?q=gestational+trophoblastic. Accessed Sept. 11, 2017.
  9. Frequently asked questions. Special procedures FAQ062. Dilation and curettage. American College of Obstetricians and Gynecologists. http://www.acog.org/publications/faq/faq062.cfm. Accessed Sept. 11, 2017.
  10. Wick MJ (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 23, 2017.