Mrs. Cynthia has been married for the past 10 years with no child. She has lost 3 pregnancies, all in the first trimester, to miscarriage in these 8 years, but that did not stop her and her very supportive husband from giving it another try. She got married to her husband at the age of 28. About 6 years before she met her husband, while still in the university, she had an abortion after her boyfriend got her pregnant and neither of them wanted to keep the baby.
She was almost 38 years old and age was not on her side. She desperately needed just a child. Luckily for her, she got pregnant and this time the pregnancy passed the first trimester (there was no sign of miscarriage). She never missed any antenatal clinic appointment with her obstetrician. In fact, she had to visit her obstetrician more frequently than usual because of having lost her previous pregnancies to miscarriage.
3 weeks into her second trimester (the pregnancy was now 16 weeks old), she started vomiting excessively. She thought this was just the normal pregnancy vomiting and didn’t bother to notify her doctor, choosing to wait until her next antenatal clinic appointment which was in two weeks’ time. But as the days passed the vomiting became very severe to the point of her nearly passing out. Then, she started bleeding slightly from the vagina in addition to passing out some grape-like tissue. She was very scared that she was again going to lose her pregnancy to miscarriage. Her husband quickly rushed her to the hospital to see her obstetrician. After examining her, including checking her blood pressure which was found to be high, in addition to running a series of medical tests which included an ultrasound scan, and a blood test for a hormone known as hCG which was abnormally high, the doctor made a diagnosis of molar pregnancy.
Molar pregnancy is a condition in which a pregnancy does not grow to form a baby; what forms is a mass of tissue from the placenta which implants in the wall of the womb like a normal pregnancy and causes the woman to manifest the signs of normal pregnancy. What are the factors that increase the risk of a woman having a molar pregnancy?
- A woman who has had a molar pregnancy in the past is very likely to have it again
- A woman who has had a miscarriage previously like Mrs. Cynthia is more at risk of a molar pregnancy compared to a woman who has never had a miscarriage
- Pregnancy at any age younger than 20 years or towards 40 years old and above has a higher risk of being a molar pregnancy compared to a pregnancy when the woman is between the ages of 20 and 35
Before a doctor concludes a woman’s pregnancy is a molar pregnancy, he or she carries out specific medical investigations which include:
- An ultrasound that usually shows no sign of a developing baby seen in a normal pregnancy. The ultrasound also shows the enlarged ovaries of the woman due to the presence of the normal pregnancy cysts which get abnormally enlarged in a molar pregnancy
- A blood test to measure the level of a hormone known as beta-hCG which is normally secreted in pregnancy but which is abnormally high in molar pregnancy.
The treatment of a molar pregnancy involves evacuating the pregnancy in a fully equipped gynaecology theatre. The woman will also be followed up for almost one year, starting a weekly follow-up appointment for the first 3 weeks and then a monthly appointment for 6 to 12 months, to measure her blood level of the beta-hCG hormone. This is to monitor for any possible transformation to cancer because molar pregnancy can turn into cancer even after it has been evacuated. Hence, these follow-up appointments are very important for the woman. The woman will also be placed on a family planning method for up to a year, usually a hormonal contraception and her husband advised to use a condom during sex, to avoid pregnancy until she has completed the follow-up appointments.
In some cases, for example, if the woman already has children, two or more, she will be advised to undergo surgery to remove her womb. Surgical removal of the womb may be the best treatment option if there is evidence of cancer resulting from the molar pregnancy.
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