Molar Pregnancy

What is a molar pregnancy?

A molar pregnancy is a type of pregnancy in which a person becomes pregnant but the pregnancy product does not develop normally due to a genetic problem, commonly known as a "grape pregnancy". There are types such as partial mole and complete mole. In a partial mole, in addition to findings belonging to the baby, some cells in the placenta become swollen and resemble fluid-filled sacs. Both organs belonging to the baby and organs belonging to the mole are present. Normally, when an egg is fertilized, one egg joins with one sperm. When there is one egg and two sperm enter and disrupt the genetic structure, the likelihood of a complete mole is high. In a complete mole, no baby forms; empty fluid-filled sacs called "grape pregnancy" form. The treatment for each type of mole is different. However, a molar pregnancy is not a healthy pregnancy. It must absolutely be evacuated.

Who is affected?

It can be seen in anyone. It is relatively more common in women with a low socioeconomic status and less healthy diets, but its exact cause is not fully known. It is seen more frequently, at 1 in 1,500, in pregnancies under the age of 20 and over the age of 40. Therefore, we can say that age is a factor.

What is the danger?

It is not a healthy pregnancy. It ends with curettage.

How does it develop?

Because the beta hCG level in the blood rises, tests for pregnancy are positive. When a person goes for a check-up thinking they are pregnant, it can be detected by ultrasound at the 6th week. If it is a partial mole, it may not give any signs until the 3rd month. For this reason, a person should go to their doctor as soon as they become pregnant and should not neglect their check-ups. However, it can only be detected by a physician. Its most important sign is vaginal bleeding, which is sometimes drip-like and sometimes can be severe. This bleeding has the appearance of grape-like fragments. This is also the reason it is called "grape pregnancy" among the public. Because the beta hCG level is much higher than in a normal pregnancy, nausea and vomiting seen during pregnancy are more intense and may be more resistant to treatment. Signs of preeclampsia (pregnancy poisoning), which begin to appear after the 20th week of pregnancy, can also accompany a molar pregnancy and appear earlier.

How is it diagnosed?

Ultrasound guides us; a gestational sac may not be seen. A snowstorm-like appearance, resembling fluid-filled sacs, forms inside the uterus, and the beta hCG value exceeds 100,000. In a partial mole, this value may not be that high and diagnosis is more difficult. In a complete mole, diagnosis is made more quickly. In a partial mole where a baby is present, it may mistakenly be thought to be a normal pregnancy. For this reason, examining the placenta in detail is very important. Both a baby is present and there is an abnormality in the placenta. It can cause serious bleeding. For this reason, the pregnancy must be terminated without waiting; however, the definitive diagnosis is made by pathology. The most important thing here is to regularly monitor the beta hCG level after evacuation. If it turns into a cancerous condition, it can be life-threatening. In these patients, since it first spreads to the vagina and lungs, a chest X-ray must be taken.

How is pregnancy evacuation performed?

General anesthesia is preferred, because, depending on the extent of spread, it is a painful procedure. It can lead to undesired situations such as uterine injury. For this reason, as soon as a person becomes pregnant, they must definitely consult their doctor and find out whether it is a healthy pregnancy.

What must a woman who has had a miscarriage do so that she does not experience a molar pregnancy? What should be done after evacuation?

It is necessary to know whether her miscarriage was a molar pregnancy. If it is a condition that requires treatment, anticarcinogenic drug therapy is applied. Along with drug therapy for a certain period, beta hCG is continuously monitored. There are certain values; these values must return to zero. If they return to zero and her doctor then says "you can get pregnant, there is no problem" (this period must be at least 1 year), she can become pregnant afterward. Also, if there is blood incompatibility, the mother must be given treatment for blood incompatibility.

In women who have had a molar pregnancy, it is important to follow up even after pregnancy, because the activity of beta hCG-producing cells continues. This can lead to problems with worse outcomes. It has been observed that in 10% of women who have had a molar pregnancy, the beta hCG level continues to rise even though the pregnancy has ended. This situation can lead to cancer, as cells that proliferate excessively metastasize to other organs through the blood. Especially, it can metastasize to the lungs and vagina and from there spread to all organs.