Molar pregnancy

Diagnosis

A health care provider who suspects a molar pregnancy is likely to order blood tests and an ultrasound. During early pregnancy, a sonogram might involve a wandlike device placed in the vagina.

As early as eight or nine weeks of pregnancy, an ultrasound of a complete molar pregnancy might show:

• No embryo or fetus
• No amniotic fluid
• A thick cystic placenta nearly filling the uterus
• Ovarian cysts

An ultrasound of a partial molar pregnancy might show:

• A fetus that's smaller than expected
• Low amniotic fluid
• Placenta that appears unusual

After finding a molar pregnancy, a health care provider might check for other medical issues, including:

• Preeclampsia
• Hyperthyroidism
• Anemia

Treatment

A molar pregnancy can't be allowed to continue. To prevent complications, the affected placental tissue must be removed. Treatment usually consists of one or more of the following steps:

• Dilation and curettage (D&C). This procedure removes the molar tissue from the uterus. You lie on a table on your back with your legs in stirrups. You receive medicine to numb you or put you to sleep.

  After opening the cervix, the provider removes uterine tissue with a suction device. A D&C for a molar pregnancy usually is done in a hospital or surgery center.

• Removal of the uterus. This occurs rarely if there's increased risk of gestational trophoblastic neoplasia (GTN) and there's no desire for future pregnancies.

• HCG monitoring. After the molar tissue is removed, a provider keeps measuring the HCG level until it goes down. A continuing high level of HCG in the blood might require more treatment.

After treatment for the molar pregnancy is complete, a provider might check HCG levels for six months to make sure no molar tissue is left. For people with GTN, HCG levels are checked for one year after chemotherapy is completed.

Because pregnancy HCG levels also increase during a regular pregnancy, a provider might recommend waiting 6 to 12 months before trying to become pregnant again. The provider can recommend a reliable form of birth control during this time.

Coping and support

Losing a pregnancy can be very hard. Give yourself time to grieve. Talk about your feelings and allow yourself to feel them fully. Turn to your partner, family or friends for support. If you're having trouble handling your emotions, talk to your pregnancy care provider or a counselor.

Preparing for your appointment

You're likely to start by seeing your family care provider or pregnancy care provider. Here's some information to help you get ready for your appointment.

What you can do

Ask a friend or family member to go with you to your appointment, if possible. Having someone there may help you remember the information you get. Make a list of the following:

• Your symptoms, including when they started and how they've changed over time.
• The date of your last menstrual period, if you remember it.
• Key personal information, including other medical conditions you have.
• All medications, vitamins or supplements you take, including doses.
• Questions to ask your provider.

For molar pregnancy, some questions to ask include:

• What is likely causing my symptoms?
• What tests do I need?
• What treatment do you recommend?
• Do I need to follow any restrictions?
• What emergency symptoms should I watch for at home?
• What are my chances of giving birth in the future?
• How long should I wait before trying to become pregnant again?
• Does my condition increase my risk of developing cancer in the future?
• Do you have brochures or printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your health care provider might ask you questions, such as:

• Have your symptoms been ongoing or occasional?
• Are you having pain?
• Compared with your heaviest days of menstrual flow, is your bleeding more, less or about the same? Have you passed grapelike cysts from your vagina?
• Have you been lightheaded or dizzy?
• Have you had a past molar pregnancy?
• Do you wish to become pregnant in the future?