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Everything about Molar Pregnancy and its Treatment

NIH reports that every 1 in 160 pregnancies is a molar pregnancy in India. Though rare, the condition is extremely serious and needs early treatment. Else, the complications include life-threatening bleeding, and formation of a rare form of cancer, and death. This page lists down everything about the condition, symptoms, treatment options, cost, insurance coverage, the best doctors in India, and more.

Table Of Index

What is a Molar Pregnancy?

Why Does it Happen?

Types of Molar Pregnancy

Risks & Complications

When To Consult a Doctor

Questions To Ask Your Doctor

Treatment Options & Cost

Insurance Coverage

Recovery Rate

Long Term Outlook

What is a Molar Pregnancy?

Molar pregnancy or also known as-‘hydatidiform mole’, is a rare form of non-viable pregnancy. That is, it cannot sustain itself and rather, must be removed at the earliest possible.

This is because, in this type of pregnancy, the embryo doesn’t develop into a child. Rather both-, the fetus and the placenta, rapidly grow in the form of a benign tumor. Because of its rapid growth, the uterus enlarges abnormally, causing acute pain, bleeding, cramping, nausea, and at times, grape-sized cyst-like expulsions from the vaginal passage.

If left untreated, it poses grave risks to the mother’s health, including, turning into a rare form of cancer, and bleeding until death.

Why Does it Happen?

A molar pregnancy can happen because of multiple reasons including-

Fertilization of an empty egg.

Double fertilization of female cell (That is, the fertilization of an ovum by 2 sperms instead of 1. Thereby, leading to 69 chromosomes in the embryo instead of the normal 46. )

The genetic tendency of the male sperm to grow abnormally faster than normal. Thereby, turning into a benign tumor rather a viable pregnancy.

Types of Molar Pregnancy

Partial Mole Pregnancy

Complete Mole Pregnancy

Risk Factors

Maternal Age (less than 20 or more than 40 years)

Race (Asian women are at a higher risk)

Genetics ( Family history of Gestational Trophoblastic Disease)

Previous molar pregnancy or GTD

Diet (Deficiency of folate, beta-carotene or protein)

Infection (sepsis of the blood or the uterus)

Preeclampsia (Very high blood pressure)

Symptoms

Severe nausea and vomiting

Pelvic pressure or pain

Dark brown to bright red vaginal bleeding during the first trimester

Vaginal passage of grape-llike cysts

Diagnosis

Transvaginal/ Abdominal ultrasound

Procedure: Both transvaginal and abdominal ultrasounds are simple, 7-10 minutes imaging tests, that is, the tests that provide an internal image of the body organ using high-frequency sound waves.

However, as the name suggests, transvaginal ultrasound is done by inserting the sound wave device through the transvaginal cavity, whereas the abdominal ultrasound is done through the abdominal surface. Since the sound wave device is closer in transvaginal ultrasound, it can help pick up the type of pregnancy earlier and is more accurate than the results of an abdominal ultrasound.

Confirmation: The shape and type of the fetus and placenta confirm the type of pregnancy. In the case of partial molar pregnancy, the fetus often looks abnormally small for its age along with low amniotic fluid and abnormal placenta. In a case of complete molar pregnancy, the fetus is absent with only a cystic placenta. In both types, the uterus too grows exceptionally larger than the one at that particular stage of pregnancy

HCG levels

Procedure: HCG stands for Human Chorionic Gonadotropin. It is a pregnancy hormone that grows with advancement in pregnancy. It is tested through a laboratory urine test.

Confirmation: In contrast to a normal pregnancy, the level of HCG is exceptionally high during molar pregnancy. At times, reaching thousands.

Self-diagnosis is a little late and difficult for molar pregnancy as many of the signs and symptoms match exactly those of normal pregnancy. Example- missed period or tenderness of the breast.

However, slowly as the pregnancy advances, it leads to severe nausea and vomiting with abnormal and acute pressure on the pelvis. At times, you may also be alarmed by bleeding or passage of grape-like cysts.

However, It is important that you do not wait for any adverse signs and rather visit your gynecologist as soon as you experience the first sign of pregnancy. An early clinical checkup and ultrasound report could help prevent severe complications and emergency surgery.

The doctor diagnoses the condition through a combination of your explained symptoms, a couple of clinical tests, an HCG report, and an ultrasound. Some of the common findings include-

High blood pressure
Traces of protein in the urine after 20 weeks of pregnancy
Enlarged uterus
No or abnormal fetus
No or abnormal placenta
Ovarian cysts
Anemia
Overactive Thyroid

Severity

If a molar pregnancy is not treated in time or the expulsion remains incomplete, it can advance and cause serious complications including gestational trophoblastic neoplasia (GTN) or persistent GTD, that is, persistent growth of the abnormal placental tissue.

In case, it is an invasive mole, the tumor can spread into the wall of the uterus and severe the range of complications and bleeding.

At times, the benign tumor can develop into a rare form of cancer and necessitate hysterectomy, chemotherapy, or other treatments.

Risks & Complications

The D&C procedure (dilation and curettage) followed by methotrexate medicine is one of the safest and most successful methods for removing the molar pregnancy. The risks are mostly mild and easily manageable. These include-

General anesthetic complications
Excessive bleeding
Blood clotting

Effect on Future Pregnancy
There is a fair 50-50 chance of both- healthy and unhealthy pregnancy after an episode of molar pregnancy. However, it is strictly advised that you try conception only after 6-12 months of the last procedure to reduce the risk of any kind of non-viable pregnancy including stillbirths, miscarriages, molar pregnancy and so.

Doctors suggest that it is best that you stay alert for signs and symptoms of the next pregnancy and take an ultrasound exam within 8-9 weeks of the missed period to avoid any complications.

You can read more about different case studies here
Myths and Facts
- Molar Pregnancy is a woman’s fault.
No. Molar pregnancy is no one’s deliberate doing. If anything, it is a genetic defect that may happen because of both or either male/ female partner.
- Molar Pregnancy is always cancerous.
No. Though molar pregnancy does increase the risk of cancer by 30%, it is not always cancerous. In most cases, it can be easily managed through the D&C procedure.
- Women with molar pregnancies cannot conceive naturally.
False. While normal pregnancy is slightly difficult in partners who have earlier had a molar pregnancy, it is not entirely impossible. In fact, reports suggest a fair 50% chance at natural conception. However, do consider another pregnancy only after 6-12 months of the procedure. And if need be, consult your gynecologist for other options through assisted reproductive technology.
Prevention
Unfortunately, molar pregnancy cannot be avoided through any specified methods. However, you can follow the following guidelines to reduce the risk and complications to a certain level:
- Avoid pregnancy at an early teen or later than 40 years of age. (for females)
- Avoid pregnancy until 6-12 months after a case of molar pregnancy.

When To Consult a Doctor

Consult your gynecologist as soon as you experience :

The first sign of pregnancy (missed period)
Abnormal vaginal bleeding
Pain/ pressure in the abdomen or pelvis
Nausea/ lightheadedness
Sudden and acute pain in the abdomen
Grape like cystic expulsions through the vagina

Our molar-pregnancy Specialist

Questions To Ask Your Doctor

What type is my molar pregnancy- a complete mole or partial mole?

What are my treatment options?

What is better for removing molar pregnancy- medicines or D&C?

Why does molar pregnancy happen?

How can I prevent molar pregnancy in the future?

What are my chances of healthy conception through natural methods?

What are my other fertility options?

What are the different modes of payment accepted?

Which insurances do you accept?

Treatment Options & Cost

While termination of molar pregnancy is possible through medicines, it is not commonly preferred because of the longer treatment method, continuous need for monitoring, and repeated follow-ups. Medical management also runs an elevated risk of incomplete abortion and repeat molar pregnancy.

However, if the molar pregnancy is detected earlier in the cycle, and the patient favors medical management, the following may be employed:

Medicine: Methotrexate

Procedure: Methotrexate is given directly by an injection in one dose. hCG levels are monitored before and after the procedure. If the levels do not decrease after the first dose, a second dose may be needed. Confirmation of termination is taken through ultrasound.

Side effects: Some of the side effects include-

Abdominal pain
Vaginal bleeding
Nausea
Vomiting
Diarrhea
Dizziness

Cost: The medical management of molar pregnancy typically costs between Rs. 2000 to Rs. 3000 in India.

Treatment: Molar pregnancy can be surgically removed through a D&C procedure followed by a methotrexate injection.

Procedure: First, the doctor gives you the medicine for the dilation of the cervix. This is particularly important for the pregnancy tissue to expel out of the birth canal. It may take 30-40 minutes or more. Then, once the cervix is dilated, the surgeon uses a curettage instrument to remove all the pregnancy tissues out of the uterus. Soon after a few hours, the cervix contracts naturally and the pregnancy is ended without any cuts or sutures.

Cost: The D&C treatment for molar pregnancy typically costs between Rs. 25,000 to Rs. 40,000 in India.

**Treatment II: In case the reports suggest a high risk of gestational trophoblastic neoplasia (GTN) and the couple has no desire for future childbirth, hysterectomy may be suggested. It can be performed through both- open-cut incision and laparoscopy. You can read more about the treatment, cost, risks, and recovery here. **

Following is a list of ways through which you can prepare well for the D&C procedure for removing molar pregnancy:

Confirm all your current medications, supplements, and herbal potions to your doctor. Certain medicines, such as ibuprofen, insulin, or blood thinners may be required to halt for a few days. This is because they can hamper the surgery and risk excessive bleeding during the procedure.

No surgery can be performed with imbalanced BP or sugar levels. This is why they must first be brought under control to proceed with the surgical treatment.

Do not eat or drink anything at least 4-6 hours before the surgery. Else, it may cause anesthesia-related complications.

Carry a pair of loose cotton clothing to change into after your surgery.

Carry a pack of soft sanitary pads to use for post-surgical vaginal bleeding.

**Regular follow-ups, routine blood tests, and HCG tests are extremely important after the molar pregnancy treatment to ensure there is no molar tissue left in the uterus. Else, it may risk infection, bleeding, and various other complications. Therefore, make sure you do not miss any follow-up tests or consultations.

Some other guidelines include-

As you wake up from the effects of anesthesia, you’ll feel considerable relief in the abdominal area. However, you might also feel slightly numb, confused, or emotionally unstable. We suggest you comfort yourself with friends, family, and your partner. (in case of discomfort or pain, a mild painkiller or sleep inducer may be suggested.)

In case your hemoglobin levels are lower than normal, a blood transfusion may be required.
In most cases, you may be discharged the same or the next day.

Insurance Coverage

Yes, insurance covers the surgical treatment cost for molar pregnancy as it falls under the ‘medically necessary’ list of treatments. However, the specifics may vary from policy to policy. Please confirm the same from your healthcare or insurance provider.

Recovery Rate

Be it medical or surgical treatment for molar pregnancy, it may take several weeks for you to recover completely. Through this time you may feel mild but constant abdominal pain or discomfort. It may take some time for your body to adapt to the changes and the period cycle to return to normal.

Video testimonial - by patient

Video on the disease and treatment - by Pristyn Care doctor

Latest Research and News

NIH’s biometric analysis of molar pregnancy in the last 50 years:
READ MORE →
News Med article on rare genes responsible for recurrent molar pregnancies-

READ MORE →
A case report by NIH on recurrent molar pregnancies in India and the Middle East:
READ MORE →
Hindawi article on incidence and management of molar pregnancy in Tertiary care hospital, Pakistan
READ MORE →
LWW journal on the management of molar pregnancy:
READ MORE →
Oatext case report on molar pregnancy
READ MORE →
Oxford Academic on subsequent pregnancies after molar pregnancy:
READ MORE →

FAQ

How common is a molar pregnancy?

Globally, one in every 1000 pregnancies is a molar pregnancy. However, NIH reports that the cases of molar pregnancy are much higher in India, that is- one in every 160 pregnancies.

Can molar pregnancy happen twice?

Yes. Reports suggest that 1 in every 100 women may have a repeat case of molar pregnancy if they have had it before.

What is the most common type of molar pregnancy?

Data reports that ‘complete molar pregnancy is a more common type of pregnancy than ‘partial molar’ pregnancies.

When is molar pregnancy most common?

Molar pregnancy is most common in early teens or with women in their forties.

Can the baby be saved in molar pregnancy?

No. The baby cannot be saved in a molar pregnancy as the embryo never grows into a normal fetus or placenta. The pregnancy is nonviable. However, in a rare case, NIH reported that “A fetus with a partial mole may survive when it occurs in a dizygotic twin, with one fetus and the other oocyte giving rise to a partial diploid mole, however, a monozygotic twin with triploidy gives rise to a partial mole with an abnormal fetus.” It also reported, “ a twin pregnancy with a hydatidiform mole and a coexisting live fetus requires a thorough evaluation, and pregnancy may be continued under close surveillance for an optimal outcome.” You can read more about it here.

Can women die because of molar pregnancy?

Yes, if the molar pregnancy is not removed in time, the woman may bleed to death or develop a rare form of cancer known as- gestational trophoblastic neoplasia (GTN).

Which type of doctor removes molar pregnancy?

A gynecologist is the most ideal doctor to remove molar pregnancies. A substantial experience of handling prior cases of molar pregnancies or gestational trophoblastic neoplasia (GTN ) is even better.

What is favored more- medical or surgical removal of molar pregnancy?

Surgical removal of molar pregnancy is the most favored method of pregnancy termination because of its immediate and confirmed results.

Is removal of molar pregnancy an emergency treatment?

Yes. If the complications are intense or the surgery is performed in the latter weeks of pregnancy, that is, when the bleeding is intense or there is an elevated risk of the pregnancy turning into gestational trophoblastic neoplasia (GTN), it falls under the ‘emergency’ bracket of surgeries. Otherwise, it is mostly an ‘elective’ procedure.

What are the chances of a healthy pregnancy after molar pregnancy?

Your chances of a healthy conception despite an earlier molar pregnancy are roughly 50%

How long should I wait before trying to become pregnant again?

Typically, doctors suggest you wait at least 6- 12 months before trying to conceive again after molar pregnancy.

When can I have sex after molar pregnancy treatment?

You can indulge in sexual intercourse after 2 weeks of your treatment. However, make sure you use contraceptives. Else, a pregnancy before at least 6-12 months after a molar pregnancy has a high chance of turning nonviable.

Why choose Pristyn Care for molar pregnancy treatment?

Pristyn Care brings the most advanced and holistic gyne treatments with its experienced doctors and latest laparoscopic and laser technology in 15+ cities in India. We are associated with multiple reputed gyne-clinics and super-specialty hospitals, giving you the option to choose amongst the best hospitals that suit your needs, be it the hospital distance, its infrastructure, or insurance panel.

As you choose Pristyn Care for your treatments, you get some of the added benefits. These include:

Free online/ in-clinic consultations: We offer free consultations. Also, you have the choice to speak with the doctor in-clinic or offline, sitting from the comfort of your home. You can ask as many questions, and we ensure we give you the right and detailed answers.

Free transportation to and from the hospital: We provide free cab pick up and drop off from and to your residence on the day of surgery.

Minimal-no waiting time for hospital admission: We perform most of our admission formalities beforehand, so you do not have to wait for hospital admission at the site.

All paperwork done on your behalf: We do all your hospital admission and discharge paperwork ourselves on your behalf to reduce your hassles and provide a seamless patient experience.

Multiple payment options: We accepts all modes of payment including cash, credit, and debit card.

All insurances accepted: We accept all insurances and offer cash-less facilities at most of the hospitals.

No cost EMI option: You can also opt for the No cost EMI option while paying for your medical bills.

Free follow-up: We provide free follow-up post consultations to ensure a complete and smooth recovery.

How to book an appointment with a Pristyn Care Gynecologist for molar pregnancy?

Booking an appointment with a Pristyn Care gynecologist is easy.

Simply call us directly or fill out our ‘Book my Appointment’ form. It would ask you just four basic questions such as ‘Your name’, ‘Contact’, ‘Disease name’, and ‘City’. Just fill them and click ‘submit’. Our medical coordinators will call you shortly and help you speak to a doctor of your choice.