Overview

A molar pregnancy — also known as hydatidiform mole — is a noncancerous (benign) tumor that develops in the uterus. A molar pregnancy starts when an egg is fertilized, but instead of a normal, viable pregnancy resulting, the placenta develops into an abnormal mass of cysts.

In a complete molar pregnancy, there's no embryo or normal placental tissue. In a partial molar pregnancy, there's an abnormal embryo and possibly some normal placental tissue. The embryo begins to develop but is malformed and can't survive.

A molar pregnancy can have serious complications — including a rare form of cancer — and requires early treatment.

Symptoms

A molar pregnancy may seem like a normal pregnancy at first, but most molar pregnancies cause specific signs and symptoms, including:

  • Dark brown to bright red vaginal bleeding during the first trimester
  • Severe nausea and vomiting
  • Sometimes vaginal passage of grape-like cysts
  • Rarely pelvic pressure or pain

If you experience any signs or symptoms of a molar pregnancy, consult your doctor or pregnancy care provider. He or she may detect other signs of a molar pregnancy, such as:

  • Rapid uterine growth — the uterus is too large for the stage of pregnancy
  • High blood pressure
  • Preeclampsia — a condition that causes high blood pressure and protein in the urine after 20 weeks of pregnancy
  • Ovarian cysts
  • Anemia
  • Overactive thyroid (hyperthyroidism)

Causes

A molar pregnancy is caused by an abnormally fertilized egg. Human cells normally contain 23 pairs of chromosomes. One chromosome in each pair comes from the father, the other from the mother. In a complete molar pregnancy, all of the fertilized egg's chromosomes come from the father. Shortly after fertilization, the chromosomes from the mother's egg are lost or inactivated and the father's chromosomes are duplicated. The egg may have had an inactive nucleus or no nucleus.

In a partial or incomplete molar pregnancy, the mother's chromosomes remain but the father provides two sets of chromosomes. As a result, the embryo has 69 chromosomes instead of 46. This can happen when the father's chromosomes are duplicated or if two sperm fertilize a single egg.

Risk factors

Up to an estimated 1 in every 1,000 pregnancies is molar. Various factors are associated with molar pregnancy, including:

  • Maternal age. A molar pregnancy is more likely for a woman older than age 35 or younger than age 20.
  • Previous molar pregnancy. If you've had one molar pregnancy, you're more likely to have another. A repeat molar pregnancy happens, on average, in 1 to 2 out of every 100 women.

Complications

After a molar pregnancy has been removed, molar tissue may remain and continue to grow. This is called persistent gestational trophoblastic disease (GTD). It occurs in about 1 of every 5 women after a molar pregnancy — usually after a complete mole rather than a partial mole.

One sign of persistent GTD is when the level of human chorionic gonadotropin (HCG) — a pregnancy hormone — remains high after the molar pregnancy has been removed. In some cases, an invasive mole penetrates deep into the middle layer of the uterine wall, which causes vaginal bleeding. Persistent GTD can nearly always be successfully treated, most often with chemotherapy. Another treatment option is removal of the uterus (hysterectomy).

Rarely, a cancerous form of GTD known as choriocarcinoma develops and spreads to other organs. Choriocarcinoma is usually successfully treated with multiple cancer drugs.

Prevention

If you've had a molar pregnancy, talk to your doctor or pregnancy care provider before conceiving again. He or she may recommend waiting for six months to one year before trying to become pregnant. During any subsequent pregnancies, your care provider may do early ultrasounds to monitor your condition and offer reassurance of normal development.

Oct. 24, 2014
References
  1. Gestational trophoblastic disease. American Cancer Society. http://www.cancer.org/acs/groups/cid/documents/webcontent/003104-pdf.pdf. Accessed July 20, 2014.
  2. Molar pregnancy. March of Dimes. http://www.marchofdimes.com/loss/molar-pregnancy.aspx. Accessed July 19, 2014.
  3. Ferri FF. Ferri's Clinical Advisor 2015: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed July 19, 2014.
  4. Goff B. Gestational trophoblastic disease: Management of hydatidiform mole. http://www.uptodate.com/home. Accessed July 19, 2014.
  5. Baergen RN. Gestational trophoblastic disease: Pathology. http://www.uptodate.com/home. Accessed July 19, 2014.
  6. Goldstein DP, et al. Gestational trophoblastic disease: Epidemiology, clinical manifestations and diagnosis. http://www.uptodate.com/home. Accessed July 19, 2014.
  7. Garner EIO. Gestational trophoblastic neoplasia: Staging and treatment. http://www.uptodate.com/home. Accessed July 19, 2014.
  8. Lentz GM, et al. Comprehensive Gynecology. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.clinicalkey.com. Accessed July 19, 2014.
  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 July 19, 2014.
  10. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Obstetrics. ACOG Practice Bulletin No. 53: Diagnosis and treatment of gestational trophoblastic disease. Obstetrics & Gynecology. 2004;103:1365.
  11. Harms RW (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 6, 2014.