Molar Pregnancy

Hydatidiform mole occurs in 1 :200 to 1 :2000 pregnancies in the United States. Invasive mole (chorioadenoma destruens) occurs in 1: 12,000 pregnancies. This is a progressive form of hydatidiform mole that has invaded the myometrium or other structures. Choriocarcinoma is an epithelial tumor that occurs in 1:40,000 pregnancies. Timely diagnosis of molar pregnancy is important because early treatment is highly effective.

Causes

Molar pregnancy is thought to be caused by a problem with the genetic information of an egg. A molar pregnancy can develop during the earliest stage of a pregnancy when an abnormal egg with no genetic information is fertilized by a sperm. The sperm's chromosomes duplicate and develop into a complete mole. A normal egg is fertilized by two sperm. This cell mass is most likely to develop into a partial mole. Factors that may increase your risk of having a molar pregnancy include:

• Age. Risk for complete molar pregnancy steadily increases after age 35.
• History of molar pregnancy, particularly if you've had two or more.
• History of miscarriage.
• A diet low in carotene. Women with low carotene or vitamin A intake have a higher rate of complete molar pregnancy.

Symptoms

• Molar pregnancy often has no specific clinical characteristics to distinguish it from a normal pregnancy in the early stages of gestation.
• Vaginal bleeding +++++
• Abdominal pain ++

Signs

• Absent fetal heart tone +++++
• Uterine enlargement may be disproportionate to the expected gestational age +++.
• Preeclampsia in pregnancy less than 24 weeks' gestation ++.
• Enlarged ovaries due to theca lutein cysts ++
• Hyperemesis gravidarum, which is frequently severe and protracted compared to normal pregnancy ++
• Anemia secondary to vaginal bleeding +++, with occasional manifestation of what appears to be hydatid vesicles from the
  vagina
• Signs of hyperthyroidism + and pulmonary trophoblastic emboli +

Treatment

Treatment such as includes:

• Suction dilation and curettage this is a surgical procedure used to remove noncancerous hydatidiform moles. The opening in the cervix is dilated and the inside uterus lining is scraped clean using suction and another spoonlike instrument.
• Chemotherapy with a single drug this treatment with medication toxic to the molar tissue is used to treat a molar pregnancy tumor that has features suggesting a good prognosis.
• Chemotherapy with multiple drugs treatment with several medications toxic to the molar tissue usually is needed to treat invasive tumors with poorer prognosis.
• Radiation treatment uses high-strength X-ray beams to destroy cancer cells in the exceedingly rare case when a tumor has spread to the brain.