InteliHealth:

= Molar=20 Pregnancy

What=20 Is It?

Symptoms

Diagnosis

Expected=20 Duration

Prevention

Treatment

When=20 To Call a Professional

Prognosis

Additional=20 = Info

What Is It?

After a sperm fertilizes an egg, = new=20 tissues develop that normally form the fetus and = placenta. A molar pregnancy, also known as = gestational=20 trophoblastic disease, occurs when the tissue = that was=20 supposed to form the placenta grows abnormally = and can=20 form a tumor that can spread beyond the womb or=20 uterus.

In a "complete mole," no normal = fetal=20 tissue forms. In a "partial mole," incomplete = fetal=20 tissues develop alongside molar tissue. These = two=20 conditions are noncancerous (benign) and make up = 80=20 percent of cases. Three maliganant forms of = gestational=20 trophblastic disease occur, including invasive = molar=20 pregnancy, choriocarcinoma and placetal site=20 trophoblastic tumors. Almost all molar = pregnancies, even=20 the cancerous type, can be cured.

Most molar pregnancies are = noncancerous=20 and confined to the uterus (hydatidiform moles). = In this=20 type of mole, the abnormal placental tissue has = villi,=20 clusters of tissue swollen with fluid, giving it = the=20 appearance of a cluster of grapes. If a fetus = begins to=20 develop along with a hydatidiform mole, it = typically has=20 many malformations and almost never can be = delivered as=20 a living baby.

A more aggressive tumor = associated with=20 molar pregnancies is an invasive mole, also = called=20 chorioadenoma destruens. The invasive mole = contains many=20 villi, but these may grow into or through the = muscle=20 layer of the uterus wall. Rarely, invasive moles = can=20 cause bleeding by perforating the uterus through = its=20 whole thickness. In 15 percent of cases, an = invasive=20 mole can spread to tissues outside of the = uterus.

Pregnancy tissues can develop = into a=20 cancer called choriocarcinoma, though this is = rare.=20 Fifty percent of choriocarcinomas form during a = molar=20 pregnancy. Others form during a tubal pregnancy, = an=20 aborted pregnancy, a miscarriage or a healthy = pregnancy.=20 Choriocarcinomas can cause persistent bleeding = in the=20 weeks or months after delivery, but this happens = very=20 rarely. (Most bleeding like this is not caused = by a=20 choriocarcinoma). Choriocarcinomas associated = with molar=20 pregnancies almost always follow complete moles = rather=20 than partial moles.

All forms of molar pregnancy, = including=20 choriocarcinoma, are more common in women of = Asian or=20 African ethnicity.

In the United States, molar = pregnancies=20 occur in about 1 in 1,250 pregnancies. = Choriocarcinoma=20 occurs in 1 in 40,000 pregnancies.

Symptoms

Hydatidiform moles can = exaggerate the=20 usual symptoms of pregnancy. Many of the = symptoms are=20 similar to those associated with miscarriage, = and most=20 women with molar pregnancies first believe they = have=20 miscarried. Invasive moles and choriocarcinomas = can=20 cause symptoms during or after pregnancy, and = symptoms=20 can develop after a hydatidiform mole has been=20 removed.

The most common symptom is = vaginal=20 bleeding, especially between the 6th and 16th = weeks of=20 pregnancy. Another symptom is bleeding that = continues=20 for a long time after delivery. Small amounts of = bleeding can show up as a watery brown discharge = from=20 the vagina. Sometimes, a piece of tissue = containing=20 grapelike shapes will pass through the vagina, = though=20 this is not common. It is important to remember = that=20 most vaginal bleeding during or after pregnancy = is not=20 associated with a molar pregnancy. However, you = should=20 report any bleeding during pregnancy to your = health care=20 professional.

A mole or choriocarcinoma also = can cause=20 the following symptoms:

Abdominal swelling, caused by the uterus = becoming=20 larger, that occurs more rapidly than expected = for the=20 first trimester of pregnancy=20

Excessive vomiting during pregnancy=20

Fatigue, often caused by anemia from heavy = bleeding=20

Sudden severe abdominal pain caused by = internal=20 bleeding=20

Pelvic cramping or vaginal discharge=20

Shortness of breath, coughing or blood in=20 coughed-up secretions because choriocarcinoma = very=20 rarely spreads to the lungs before it is = diagnosed=20

There are many other causes for = these=20 symptoms, so if you have such problems don't = assume you=20 have a molar pregnancy. Always speak with your = health=20 care professional. Usually, these symptoms are=20 associated with a normal pregnancy.

Diagnosis

Your doctor may suspect you have = a molar=20 pregnancy based on symptoms you have during or = after=20 pregnancy, or because your uterus is unusually = large.=20 You doctor may suspect a molar pregnancy if you = have a=20 high level of human chorionic gonadotropin = (HCG), the=20 hormone measured in a routine pregnancy test. = All=20 pregnancies with high levels of HCG are not = moles,=20 however, and some molar pregnancies do not have = high=20 levels of HCG.

An ultrasound=20 of the pelvis typically can confirm a diagnosis = of a=20 molar pregnancy. Ultrasound uses sound waves to = show an=20 image of the contents within the uterus.

If you have a molar pregnancy, = further=20 testing will be done to determine the type of = mole and=20 the possibility of it having spread outside the = uterus.=20 Testing may include X-rays,=20 computed=20 tomography (CT) scans or magnetic=20 resonance imaging (MRI) scans to view the = chest,=20 abdomen, pelvis and brain. Additional blood = tests may be=20 needed. A pathologist will look at the molar = tissue=20 under a microscope once it is removed to confirm = the=20 diagnosis.

Expected Duration

Treatment for some molar = pregnancies can=20 take several months. Following treatment, you = will need=20 to have repeated blood tests and checkups over = one to=20 two years, to be sure that all molar tissue has = been=20 treated and that the problem has not = returned.

Prevention

Although any woman who becomes = pregnant is=20 at some risk of developing one of these uncommon = conditions, the risk appears to be higher in = pregnant=20 women who are younger than age 20 or older than = age=20 40.

The best way to prevent = complications from=20 an invasive mole or a choriocarcinoma is to = receive=20 routine prenatal care by a qualified health care = professional, so that problems can be identified = as=20 early as possible.

Treatment

The results of diagnostic tests = will help=20 to determine a treatment plan. Options almost = always=20 include surgery to remove the tumor. More = aggressive=20 types of molar pregnancy may require chemotherapy=20 and/or radiation=20 therapy. About 85 percent of hydatidiform = moles can=20 be treated without chemotherapy. Treatment = options=20 include:

Suction dilation and curettage (D and = C) =97=20 This is a surgical procedure used to remove=20 noncancerous hydatidiform moles. The opening = in the=20 cervix is dilated and the inside uterus lining = is=20 scraped (curetted) clean using suction and = another=20 spoonlike instrument.

Removal of the uterus (hysterectomy)=20 =97 This is used rarely to treat = hydatidiform moles=20 but may be chosen, particularly if the woman = does not=20 want to become pregnant again.

Chemotherapy with a single drug =97 = This=20 treatment with medication toxic to the molar = tissue is=20 used to treat a molar pregnancy tumor that has = features suggesting a good prognosis.

Chemotherapy with multiple drugs = =97=20 Treatment with several medications toxic to = the molar=20 tissue usually is needed to treat invasive = tumors with=20 poorer prognosis.

Radiation treatment =97 This uses=20 high-strength X-ray beams to destroy cancer = cells in=20 the exceedingly rare case when a tumor has = spread=20 (metastasized) to the brain.

When To Call a Professional

For any pregnancy, make sure you = have=20 appropriate prenatal care beginning in the first = trimester, with regular checkups. Report any = bleeding,=20 excessive vomiting or abdominal pain during = pregnancy to=20 your doctor. If you have prolonged vaginal = bleeding=20 after childbirth, an abortion or a miscarriage, = contact=20 your doctor for an evaluation.

Prognosis

With appropriate treatment, all=20 hydatidiform moles are curable, and nearly all = cases of=20 more aggressive molar tumors can be cured. Even = with=20 tumors whose features categorize them as having = a poor=20 prognosis, 80 percent to 90 percent are cured = with a=20 combination of surgery and, if needed, = chemotherapy.

It is important for women with = molar=20 pregnancies to be evaluated periodically after = the=20 problem has been treated. Women are advised not = to=20 attempt pregnancy for some time in order to be = sure that=20 levels of HCG remain at zero and that no further = treatment is needed. There is a risk that a = molar=20 pregnancy can come back after treatment. = Recommendations=20 are changing and vary by hospital.

It is usually possible for women = to have a=20 normal, healthy pregnancy after treatment for a = molar=20 pregnancy.

Additional Info

American=20 Cancer Society (ACS)
1599 Clifton Road, = NE=20
Atlanta, GA 30329-4251
Toll-Free: = 1-800-227-2345=20
http://www.cancer.org/

National=20 Cancer Institute (NCI)
U.S. National = Institutes=20 of Health
Public Inquiries Office
Building = 31,=20 Room 10A03
31 Center Drive, MSC = 8322
Bethesda, MD=20 20892-2580
Phone: 301-435-3848
Toll-Free:=20 1-800-422-6237
TTY: 1-800-332-8615
E-Mail: = cancergovstaff@mail.nih.gov
http://www.nci.nih.gov/

Office=20 of Rare Diseases
National Institutes of=20 Health
6100 Executive Blvd.
Room 3B01, MSC = 7518
Bethesda, MD 20892-7518
Phone:=20 301-402-4336
Fax: 301-480-9655
E-Mail: ord@od.nih.gov
http://rarediseases.info.nih.gov/

Last updated May 10, = 2007

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