X
Table of contents

Molar pregnancy

Feel like sharing?

What is molar pregnancy?

A molar pregnancy occurs when the placenta develops abnormally, forming a mass of tissue (known as a mole) inside the uterus.

A molar pregnancy is sometimes also known as a hydatidiform mole. The abnormal placental tissue is usually benign, but in some cases it can develop into more serious forms of gestational trophoblastic disease (GTD), which can include cancer.

Molar pregnancy is not common. Estimates vary, but it occurs in around one of every 1000-1500 pregnancies. [1] [2]

Signs and symptoms

A molar pregnancy is usually detected early in a pregnancy. It often ends in a miscarriage and is not able to form a viable pregnancy.

Symptoms include:

In a small number of cases, women with a molar pregnancy can also experience symptoms of:

With a molar pregnancy there are usually symptoms that it is not a normal pregnancy; however, some women may have a miscarriage and not be aware that they have had a molar pregnancy unless the tissue from the miscarriage is tested.

Causes

A molar pregnancy occurs because, at conception, the embryo develops with an extra set of chromosomes from the father. Why this occurs is not known.

In a normal embryo, cells contain one set of chromosomes from the mother and one set from the father. In a molar pregnancy, more than one set of chromosomes come from the father, either because the chromosomes from one sperm have been duplicated, or because two separate sperm have fertilized the mother's egg (ovum). A complete molar pregnancy occurs when the egg contains no chromosomes, whereas in a partial molar pregnancy the egg contain the normal 23 chromosomes.

This interferes with the normal development of the embryo. The part of the embryo that would have become the fetus (the developing baby) either does not develop at all, or is abnormal. The fetus is not viable and does not survive beyond the first few months of pregnancy.

The placenta, which also develops from the outer cells of the embryo, grows more quickly than usual and forms an abnormal mass of tissue inside the uterus. It produces the hormone human chorionic gonadotropin (hCG), which causes many of the signs of pregnancy, such as morning sickness and tender breasts.

Types of molar pregnancy. 

Types

Complete and partial

Molar pregnancies can be:

The risk of developing more serious forms of gestational trophoblastic disease is slightly higher with complete molar pregnancies.

Invasive and non-invasive

In some cases, the placental tissue can grow into the wall of the uterus. This is called an invasive mole.

Gestational trophoblastic disease (GTD)

In about 10% of women who have a molar pregnancy, levels of hCG do not return to normal [1] . This is called persistent gestational trophoblastic disease (GTD). Symptoms can include vaginal bleeding and pain and swelling in the abdomen that continue after the pregnancy.

In rare cases, the abnormal placental tissue can develop over time into cancer.

Forms of cancer that can occur in gestational trophoblastic disease include:

These cancers can occur following normal pregnancies as well as molar pregnancies and can spread to the rest of the body, particularly the lungs, liver and brain.

Risk factors

Women may be at an increased risk of having a molar pregnancy if they:

  • Are of Asian background;
  • Are under 20 or over 40 years of age, and;
  • Have a history of previous gestational trophoblastic disease (including molar pregnancy).

Methods for diagnosis

In some cases, a molar pregnancy will be detected as part of a routine ultrasound during early pregnancy. Your doctor will ask you about your symptoms and your medical history. They may ask questions about any previous pregnancies, births, miscarriages or abortions.

Tests may include:

Other tests such as a computerized tomography (CT) scan or magnetic resonance imaging (MRI) may be recommended if other health conditions (including more serious forms of gestational trophoblastic disease) are suspected of causing symptoms.

Types of treatment

In most cases, the main treatment for molar pregnancy is to remove the abnormal placental tissue.

Treatments that may be recommended include:

In a molar pregnancy, there will often be continued symptoms, such as vaginal bleeding following a miscarriage. Evacuation of the uterine contents may be recommended to ensure that all of the abnormal placental tissue has passed out of the uterus. This can be done using surgery or medication depending on individual circumstances.

Gestational trophoblastic disease often requires treatments such as chemotherapy.

Follow-up monitoring

If any of the abnormal placental cells remain in the uterus, they can develop into more serious forms of gestational trophoblastic disease. To monitor this, levels of hCG are regularly tested in the weeks and months after the end of the pregnancy, to ensure it returns to normal levels. This may be done by urine or blood tests.

To ensure hCG levels return to normal, you will generally be advised to avoid getting pregnant again for a certain period of time.

Women who have had one molar pregnancy have an increased risk (about one in 100) of having it occur again in a later pregnancy. [1] To detect any problems early, you may be recommended to have:

Counselling

When a pregnancy ends, it can be very distressing and recovering emotionally can take time. Speaking to your doctor or a mental health professional can help. Counselling services may be available at your hospital.

Counselling can assist with the emotional recovery from a molar pregnancy. 

Prognosis

In most cases, treatment of a molar pregnancy by evacuation of the uterus is successful. Most women can have normal pregnancies in the future, although there is about a one in 100 chance of having another molar pregnancy. Having regular check-ups and following your doctor's instructions can help to detect any signs of more serious gestational trophoblastic disease.

Prevention

While molar pregnancies cannot be prevented, seeking antenatal care once you know you are pregnant can help to detect signs early.

References

  1. Royal Women’s Hospital (Melbourne Vic). (2014) The Women’s health book: a complete guide to health & wellbeing for women of all ages. North Sydney N.S.W.: Random House Australia.
  2. Gestational trophoblastic disease. Cancer Australia. Accessed August 12 2014 from link here
  3. Gestational Trophoblastic Disease | Cancer Australia. Accessed August 12 2014. link here
  4. Hydatidiform Mole - National Library of Medicine - PubMed Health. Accessed August 12 2014. link here
  5. Hydatidiform Mole | The Royal Womens Hospital. Accessed August 13 2014. link here
  6. Management of Gestational Trophoblastic Disease (C-Gyn 31) New Statement Nov13.pdf Royal Australian and New Zealand College of Obstetricians and Gynaecologists - College Statements & Guidelines. Accessed August 14 2014. link here
  7. Pregnancy Related Cancer | Better Health Channel. Accessed August 12 2014. link here
  8. Australia Random House. The Womens Health Book. Random House Australia 2014.

9 Most frequently asked questions (FAQs)

What is a molar pregnancy?
A molar pregnancy occurs when the placenta develops abnormally, forming a mass of tissue (known as a mole) inside the uterus. It is sometimes also known as a hydatidiform mole.
What are the symptoms of a molar pregnancy?
A molar pregnancy is usually detected early in a pregnancy. It often ends in a miscarriage and is not able to form a viable pregnancy. Symptoms include: vaginal bleeding during the first three months of pregnancy; growth of the uterus that does not correspond to the length of the pregnancy (it may be too large or too small); severe morning sickness, and; no fetal heartbeat or movement, although molar pregnancy is almost always detected before this becomes an issue. In a small number of cases, women with a molar pregnancy can also experience symptoms of hyperthyroidism and pre-eclampsia, although earlier in pregnancy than it usually occurs (the first and early part of the second trimesters).
What causes a molar pregnancy?
A molar pregnancy occurs because at conception the embryo develops with an extra set of chromosomes from the father. Why this occurs is not known. In a normal embryo, cells contain one set of chromosomes from the mother and one set from the father. In a molar pregnancy, more than one set of chromosomes come from the father, either because the chromosomes from one sperm have been duplicated, or because two separate sperm have fertilized the mother's egg. A complete molar pregnancy occurs when the egg contains no chromosomes, whereas in a partial molar pregnancy the egg contain the normal 23 chromosomes.
Who can have a molar pregnancy?
Molar pregnancy is not common. However, women may be at an increased risk of having a molar pregnancy if they: are of Asian descent; are under 20 or over 40 years of age, or; have a history of previous gestational trophoblastic disease (including molar pregnancy).
How is a molar pregnancy diagnosed?
In some cases, a molar pregnancy will be detected as part of a routine ultrasound during early pregnancy. Your doctor will ask you about your symptoms and your medical history. They may ask questions about any previous pregnancies, births, miscarriages or abortions. Tests may include: a pelvic examination; an ultrasound to investigate the uterus, and; a blood test to detect levels of human chorionic gonadotropin. Other tests such as a computerized tomography (CT) scan or magnetic resonance imaging (MRI) may be recommended if other health conditions (including more serious forms of gestational trophoblastic disease) are suspected of causing symptoms.
How is a molar pregnancy treated?
In most cases, the main treatment for molar pregnancy is to remove the abnormal placental tissue. Treatments that may be recommended include: evacuation of the uterine contents, and; hysterectomy (which may be an option for older women who do not want any more children). If any of the abnormal placental cells remain in the uterus, they can develop into more serious forms of gestational trophoblastic disease. To monitor this, you will have regular blood or urine tests in the weeks and months after the end of the pregnancy. You will generally be advised to avoid getting pregnant again for a certain period of time.
Are there different types of a molar pregnancy?
Molar pregnancies can be either complete, in which there is only abnormal placental tissue (and no fetus), or partial, in which there is an abnormal fetus and sometimes some normal placental tissue.
What is the outlook for a molar pregnancy?
In most cases, treatment of a molar pregnancy by evacuation of the uterus is successful. Most women can have normal pregnancies in the future, although there is about a one in 100 chance of having another molar pregnancy. Having regular check-ups and following your doctor's instructions can help to detect any signs of more serious gestational trophoblastic disease.
Is a molar pregnancy serious?
While a molar pregnancy can usually be removed successfully and without any complications, ending a pregnancy can still be distressing. Speaking to your doctor or a mental health professional can help. Counselling services may be available at your hospital. If any abnormal placental cells remain in the uterus, they can develop into more serious forms of gestational trophoblastic disease.

Related topics

Miscarriage

Miscarriage is defined as the loss of a pregnancy before it has reached 20 weeks’ gestation. If a loss of pregnancy occurs after 20 weeks, it is known as a stillbirth. Miscarriages often occur without any obvious cause. When a pregnancy ends prematurely, it can be very distressing; however, counselling and support are available.

Morning sickness

Morning sickness is nausea and vomiting during pregnancy. Despite its name, it can strike at any time of the day. Up to around 85% of pregnant women experience morning sickness. Fortunately, it tends to settle down by the 20th week of pregnancy.

Motion sickness

Motion sickness describes the feelings of dizziness and nausea that occur when you’re travelling in a moving vehicle. Your eyes may see the landscape passing by at high speed, while the balance sensors in your inner ear are sensing that you’re sitting still. This confusing information is felt as motion sickness.

Placental abruption

A placental abruption occurs in pregnant women when the placenta detaches from the wall of the uterus before the baby has been born. Also known as abruptio placenta, this is an emergency that can threaten the life of both mother and baby.

About this article

Title: Molar pregnancy

Author: Kellie Heywood

First Published: 28 Nov 2014

Last reviewed: 17 Jan 2022

Category: Information on Molar pregnancy

Average rating: 4.5 out of 5 (1407 votes)

Processing your vote now...

Sorry your vote failed to process.

Rate this report below.

Feel like sharing?

X

Your privacy

We use cookies to improve our website and service. By continuing to browse this website you accept the use of cookies by us and our partners. If you require more information please read our privacy policy and terms and conditions before proceeding.