Molar pregnancy

A molar pregnancy is an abnormal form of pregnancy where a fertilized egg develops into a mass of abnormal cells, instead of a viable fetus. It is a type of gestational trophoblastic disease (GTD).

Invasive hydatidiform mole - high mag

Classification

• Molar pregnancies are classified into two types, complete and partial.
• Complete moles occur when an egg without a nucleus is fertilized by a sperm. Instead of forming an embryo, all the placental tissue grows into a mass of cysts, resembling a cluster of grapes. Complete moles usually have no normal fetal tissue.
• Partial moles result when two sperm fertilize a normal egg, leading to an abnormal placenta and an abnormal fetus. The fetus usually has severe defects and cannot survive.

Epidemiology

Molar pregnancies are rare, occurring in approximately 1 in 1,000 pregnancies. They are more common in women at the extremes of reproductive age and those with a previous history of molar pregnancy.

Symptoms and Diagnosis

• Molar pregnancies often present with symptoms of pregnancy such as missed periods, positive pregnancy test, morning sickness, and rapid uterine enlargement. However, some distinguishing features include unusually severe morning sickness, spotting or bleeding, and the absence of fetal heart tones.
• Diagnosis is confirmed by an ultrasound which shows a "snowstorm" or "bunch of grapes" appearance due to the presence of multiple cysts. Additionally, serum human chorionic gonadotropin (hCG) levels are markedly elevated.

Treatment and Follow-Up

Treatment involves the removal of molar tissue from the uterus, usually by suction dilation and curettage (D&C). After evacuation, it's important to monitor hCG levels regularly until they normalize, as persistent or increasing hCG levels can indicate the presence of gestational trophoblastic neoplasia (GTN), a serious but treatable complication of molar pregnancy.

References

<references>

• Seckl, M. J., Sebire, N. J., & Berkowitz, R. S. (2010). Gestational trophoblastic disease. The Lancet, 376(9742), 717-729.
• Lurain, J. R. (2011). Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia. American journal of obstetrics and gynecology, 204(1), 11-18.
• American College of Obstetricians and Gynecologists. (2019). Gestational Trophoblastic Disease: ACOG Practice Bulletin, Number 53. Obstetrics & Gynecology, 133(1), e1-e18.

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