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    Dr. Mallavarapu Tripura Sundari (pv40LSnvGv)

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    Dr. Sadhana Mehta (RkKuoHRaq7)

    Dr. Sadhana Mehta

    MBBS, MS-Obs & Gyne
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    Dr. Mangala Keerthi (hw6VE8pi6e)

    Dr. Mangala Keerthi

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  • What is a Molar Pregnancy
    Tests and Diagnosis
    Risks & Complications
    Myths and Facts
    Treatment Options
    Before and After Surgery
    Insurance Coverage

    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.

    Risk Factors and Symptoms - Molar Pregnancy

    Risk Factrors

    • 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)


    • 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

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    Tests and Diagnosis for Molar Pregnancy Treatment


    • 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.

    Diagnosis by Doctor

    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

    Risks & Complications - Molar Pregnancy

    During the Surgery

    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

    If Left Un-treated

    Removal of molar pregnancy is a must. Else, it risks a 30% chance of growing into a rare form of cancer (higher in case of complete molar pregnancy) and severe bleeding leading to anemia and sometimes- death.

    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.

    Myths and Facts - Molar Pregnancy

    • 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.

    Treatment Options & Cost - Molar Pregnancy

    Medical Termination

    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.

    Surgical Termination

    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**

    Before and After Molar Pregnancy Treatment

    Surgery Preparation

    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.

    What to Expect During Surgery?

    • The procedure is performed under the influence of general anesthesia.
    • On average, it may take anywhere between 45 and 60 minutes.

    After the Surgery

    **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 of Molar Pregnancy Treatment

    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 of Molar Pregnancy Treatment

    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.

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    FAQs around Molar Pregnancy Treatment

    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.