Information

• Age. Risk for complete molar pregnancy steadily increases after the age of 35
• History of molar pregnancy, particularly if you’ve had two or more
• Possible ovulatory disorders

• History of miscarriage
• A diet low in carotene (a form of vitamin A). Women with low carotene or vitamin A intake have a higher rate of complete molar pregnancy
• Living in certain geographic locales (especially Southeast Asia and Mexico)

Complete hydatidiform moles also have a characteristic appearance on an ultrasound scan so this, and the fact that no developing foetus is seen when you have a scan at the ante-natal clinic, can allow the diagnosis to be suspected.

Treatment may be a medical evacuation (tablets are inserted into the vagina and taken orally) or a dilatation and curettage (D & C, or “scrape”) to remove as much of the molar tissue from the womb as possible. This is a minor operation which is carried out after most miscarriages under a general anaesthetic. In most cases, one or two of these minor operations will be enough to remove the mole permanently.

In a normal pregnancy the placenta makes many hormones to support itself, the baby and the mother. One of these hormones is called human chorionic gonadotrophin (hCG), and in a molar pregnancy, where there is overgrowth of the placenta, there is a large amount of this hormone produced.

hCG circulates in the mother’s blood and hCG is excreted in her urine. These can be readily measured in the laboratory from blood or urine samples. This is useful in helping with the diagnosis of the condition, but even more useful in helping decide when a patient is cured. When there is no disease in the body, the level of hCG in the blood and hCG in the urine is low. When there is a lot of disease the level is high. As the disease resolves the levels fall gradually. These tests are important because it is possible to monitor how your disease is progressing.

Please refer to your regional centre for specifics as follow up procedures between centres may differ slightly.

However, as mentioned earlier, even a tiny amount of mole tissue left in the body can grow and spread via your blood stream and this can happen up to many months after apparent cure. Thus your disease will probably be monitored by urine samples for a period of around six months.

However, if the level stays high or starts to rise, this will be detected at the specialist regional centre. The centre will contact you. In some cases drug treatment in the form of chemotherapy is required to eliminate any remaining disease. You are more than welcome to call the centre for your urine results. Up to 10% of women require further treatment in the form of chemotherapy if their hCG hormone levels do not reduce on their own or remain the same.

All this is relatively straightforward. However, because we assess your disease by measuring a hormone normally only seen in pregnancy, if you become pregnant during the course of your follow-up with urine samples, the healthy pregnancy will result in the rapid rise of hCG levels in your urine, which might lead to unnecessary worry and confusion.

Monospermic

Involving or resulting from a single sperm cell

Dispermic

The entrance of two spermatozoa into one egg

Normal Conception

Partial Mole

Monospermic Complete Mole

Each individual’s case is different but the vast majority of patients begin on Methotrexate. This is also used for arthritis and skin conditions. It is administered by intra-muscular injections (buttock) followed by a Folinic Acid (NOT folic acid) tablet exactly 24 hours later. The usual regimen is to have four injections on alternate days with Folinic Acid in between but regimens differ at different treatment centres. You will stay as an in-patient for the first part of the course of treatment as the chemotherapy could cause heavy bleeding and other side effects. You will then continue as an outpatient either at your treatment centre or it may be possible to arrange it at your local hospital to avoid commuting long distances.

The level of hCG may reach normal (different regions aim for different levels between 2-5) or become undetectable when there is still a residual tumour burden of cells. Therefore with all regimens, treatment is continued for at least six weeks.

Actinomycin D is given intravenously and repeated every 2 weeks.

Side effects:

Generally it is tolerated well with an increase in tiredness compared to the methotrexate.

• Hair thinning: you do not experience total hair loss and the hair fully recovers after the end of treatment.
• Nausea and vomiting: treated with simple anti sickness drugs
• Constipation: this is usually caused by the side effects from the anti-sickness medication and you will be given stool softeners and laxatives

For most women the emotional healing takes much longer than the physical healing from surgery. Even if the pregnancy ended very early, the sense of bonding between a mother and her foetus is often very strong. The feelings of loss can be extremely intense for some couples.

Grief can involve many feelings. One may find oneself looking for reasons why the pregnancy ended. You or your partner may wrongly blame yourselves (or secretly each other). Sickness can manifest itself in the form of headaches, loss of appetite or tiredness.  There may be problems with concentrating or sleeping.

Never underestimate unexplained miscarriages, and having to cope with a Molar Pregnancy on top of this is shattering. For those diagnosed with a complete molar they have to come to terms that there was never an embryo or baby. This can be quite destroying especially when the body produces all the normal signs of being pregnant. Although painful, still acknowledge that you conceived and that you and your partner still created something. And if it helps hold a ceremony/memorial for your lost one (no matter how early or late into pregnancy you were) for closure. It will be hard if you are receiving treatment months down the line. Maybe consider it once your treatment has finished then you don’t have that constant reminder of what has happened.

The feelings of grief are usually different between the man and woman; after all, it is the woman that has felt the physical changes of pregnancy.

Talking to each other in a very honest manner is the best way for a man to assist both his partner and himself in the recovery process.  Letting her know that she is not alone in her grief can be a true comfort for her. Crying together, explaining yourself and listening to your partner may help on the road to recovery for the both of you.

If either of you are having trouble handling your feelings, try talking to your doctor or close friends or family or even a qualified counsellor. They may not understand your condition but sometimes it helps to talk to someone neutral who can have an objective view on your situation.

Most importantly of all, don’t blame yourselves for the pregnancy loss.

An early pregnancy loss does not mean that you cannot have any more children.  The vast majority of women that suffer an early pregnancy loss have a healthy pregnancy later, but do not rush to your decisions too quickly, be sure that both of you are emotionally healed and strong enough to make another attempt.