Birth and parenting expert Janine Gard.
OPINION:
Janine Gard is a diploma-qualified birth educator (2005) and founder of Bellies to Babies antenatal and postnatal classes. She has helped more then 3700 parents prepare themselves mentally, emotionally and physically for their journey to parenthood and loves what she does. This week she talks about molar pregnancies.
A molar pregnancy — also known as hydatidiform mole — is a rare complication of pregnancy characterised by the abnormal growth of trophoblasts, the cells that normally develop into the placenta.
In New Zealand, it is estimated that one in every 1200 pregnancies will be a molar pregnancy. Having a previous molar pregnancy increases the chance of having another molar pregnancy to between one in 100 and one in 50.
There are two types of molar pregnancy: complete molar pregnancy and partial molar pregnancy.
In a complete molar pregnancy, this occurs when the centre of the women's egg becomes lost or inactivated during fertilisation. As a result, the fertilised egg contains no genetic material from the mother. All of the genetic material is from the father and this genetic mix does not form a baby, instead, an unusual cluster of tissue grows in the placenta.
In a partial molar pregnancy, this occurs when two sperm cells fertilise an egg. This usually results in a baby with an abnormal amount of genetic material, which is unable to develop normally. It also causes abnormal placental tissue to develop. In a partial molar pregnancy, a baby can develop but it will be abnormal and cannot survive.
A molar pregnancy may seem like a normal pregnancy at first, including morning sickness, tiredness and breast tenderness. Around the 10th week of pregnancy some additional symptoms may appear:
• Dark brown to bright red vaginal bleeding during the first trimester with grape-like cysts.
• Severe nausea and vomiting.
• Pelvic pressure or pain.
If you experience any signs or symptoms of a molar pregnancy, consult your LMC or health care provider. They will detect other signs of a molar pregnancy, such as:
• Rapid uterine growth — the uterus is too large for the stage of pregnancy.
• High blood pressure.
• Preeclampsia — a condition that happens later in pregnancy not early on.
• Ovarian cysts.
• Anemia.
• Overactive thyroid (hyperthyroidism).
• High levels of the pregnancy hormone human chorionic gonadotropin, or hCG, confirmed by a blood test.
What causes a molar pregnancy?
Molar pregnancies are rare, any woman can develop a molar pregnancy but there are some factors that can increase the risk of this occurring such as:
• Women under 20 years old.
• Women aged over 35.
• Women who have had a molar pregnancy before.
Treatment:
A molar pregnancy usually needs to be removed surgically to avoid complications. This is usually done in a hospital where a specialist will gently remove and collect the tissue from the uterus. The procedure is called a curette (or dilatation and curettage, or D&C) and is done under a general anaesthetic. The vagina is held open by a speculum and the cervix is widened. Suction is used to remove the tissue from the uterine wall. This tissue is then examined by a pathologist. The tissue sample can be tested to determine if it's a complete or partial mole. in some cases, the diagnosis occurs after a miscarriage when the products of pregnancy are examined.
Possible complications of a molar pregnancy:
About 20 per cent of complete and about 2 per cent of partial molar pregnancies will continue to grow inside the uterus despite and D&C. This can lead to vaginal bleeding or is detected by follow-up blood tests showing high levels of hGC. This is called an invasive mole and is treated with chemotherapy. Very rarely an invasive mole can invade other organs - chemotherapy an effective way to treat this.
Follow-up care:
Although most women whose molar pregnancies are removed require no further treatment, follow up care is extremely important. This usually includes a chest x-ray and blood tests to check hormone levels, liver, kidney and thyroid function. If it was a complete mole hormone levels are usually checked weekly until three consecutive results are within the normal range, then checked monthly for six months. If was a partial mole these monthly tests are not required.
A molar pregnancy does not affect the chances of getting pregnant again. However, most are advised to wait for your doctor's all-clear to fall pregnant again. A new pregnancy would cause your hCG level to rise, making it difficult to ensure it is not due to the molar tissue growing back.
It can take time to recover emotionally and physically from a molar pregnancy. Waiting to find out if everything is okay after a lot of tests can be very stressful.
Try to remember that most women who have had a molar pregnancy go on to have healthy pregnancies and babies in the future.
You may find it helpful to:
• Talk to your partner, family or friends about how you feel.
• Ask your health care provider what support is available – they may refer you to a counsellor who specialises in support for people affected by pregnancy loss
■ Bellies to Babies antenatal and postnatal classes, baby massage courses and baby and infant first aid courses: 2087 Pakowhai Rd, Hawke's Bay, 022 637 0624. https://www.hbantenatal-classes.co.nz/
■ Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians.