The Hydatidiform Mole and the Miscarriage

The Hydatidiform Mole and the Miscarriage

  Autor NN Team Data: 18.06.2009

The Hydatidiform Mole and the Miscarriage
The hydatidiform mole (also caller molar pregnancy) is a rare but severe complication of the pregnancy. To explain the term in a few words, the mole is an abnormality of the placenta caused by an error in the cells division which turns into a noncancerous but invasive tumor. 

There are two types of mole partial and complete. The complete mole contain only placenta tissue, meaning it has no embryo. This happens when a sperm fertilizes an empty egg. As the egg is empty, the embryo cannot be created, but the placenta exists and secretes the, thus meaning that the pregnant woman has the common symptoms of a pregnancy. The ultrasound will show there is no embryo but only placenta. 

The partial mole is when two sperm fertilize the egg. Something does wrong and there occurs an error, and instead of creating two twin embryos, only one embryo with too many chromosomes is created, therefore this is abnormal, with an abnormal placenta. Because of the genetic defects, he cannot survive and dies in the uterus. 

Therefore, the hydatidiform mole is a natural accident, and nobody is to blame for it, nor the mother or the father. It has nothing to do with the parents behavior, but it seems that the risk is higher as the women is older. Most frequently, the mole occurs after a miscarriage, after an ectopic pregnancy but also after a normal pregnancy and birth. 

A woman with a molar pregnancy has the normal symptoms of a pregnancy until one point when there occur bleedings, vomiting and nausea. There might occur more severe complications sometimes, such as thyroid disorders or pre- eclampsia. The doctor will look for the signs of a miscarriage and will notice a smaller or larger uterus than normally. The ultrasound will show the lack of an embryo or his abnormal shape, the enlarged ovaries because of the cysts caused by a high level of hCG. Actually, a higher level than normally of the hCG is a symptom of molar pregnancy. 

Sometimes, the body of a woman rejects the mole on its own, by miscarriage. Sometimes it doesn't. The treatment is a surgical curettage dome with a device similar to an aspirator. In cases when the woman is older and doesn't want any more children, the hysterectomy might be done directly (the surgical removal of the uterus) in order to avoid other complications. 

After removing the mole, it is necessary to see the doctor regularly. This is recommended and also the histerectomy is sometimes indicated for this, because hydatidiform mole acts like a tumor. If there are a few cells of it left, the mole regenerates, gets into the blood vessels of the uterus, then into the circulatory system and might reach other organs and even the brain. 

It is recommended to see the doctor at every two weeks until the uterus gets back to the normal size, then at every three months for one year. The level of hCG muct be checked weekly until it reaches zero, then once a month for a year. This year, the woman is not allowed to get pregnant again. 

All the tests and checks are very important because the hydatidiform mole tends to regenerate on other organs too, same as cancer. Fortunately, the mole regenerates in only 20% of the complete molar pregnancies. At the partial ones, the risk is even lower. That waiting year recommended by the doctor is frustrating for couples who want children, but it must be respected as a new pregnancy would complicate the situation. The doctor would not know if the high level of hCG is caused by a new pregnancy or from the regenerated mole. 

If after the surgical curettage the level of hCG decreases and increases again, it means that the mole regenerated from the microscopic cells left in the uterine wall. These cells act as a cancer tumor and spreads to other organs too (lungs, brain, bones, vagina). The treatment of a recurrent mole (also called gestational trophoblastic neoplasia) consists in chemotherapy with a medicine called methotrexate usually. Fortunately, the methotrexate has no strong side effects and is easy to bear. This can be administered intramuscular and usually you need only one dose. Also, if a gestational trophoblastic neoplasia is suspected, the woman must go through a set of tests which include a CT of the brain, lungs and abdomen. Again, the hCG level is measured weekly until it reaches zero. 

After a complete treatment, the risk of a second molar pregnancy is of only 1%. the patient who get pregnant again after a molar pregnancy may be easily monitored with the ultrasound test which detects the abnormalities of a hydatidiform mole immediately. But it is important for the woman who had a mole, to see the doctor urgently when the signs of a new pregnancy appear in order to make sure that she is not dealing with a gestational trophoblastic neoplasia. 

Read the English version of this article: The Hydatidiform Mole and the Miscarriage