Molar pregnancy and GTD

A molar pregnancy occurs when the fertilization of the egg does not take place correctly. Instead, the cells start to grow abnormally inside the uterus. It begins with a layer of cells called trophoblast that is usually present around the embryo. It is these cells that develop into placenta but in this case the cells change and forms an abnormal mass. Usually, GTD is not cancerous but some are malignant. GTD is curable if found early.

One may identify that they have a molar pregnancy either in their scan at around 8 to 14 weeks., else when they have a miscarriage as in molar pregnancy the fetus will not survive.

The gestational trophoblastic disease is of two types- molar pregnancy and gestational trophoblastic neoplasia.

Molar pregnancy

This is the most common form of GTD and is also known as Hydatidiform Mole(HM). They are of two types-

  • Complete molar pregnancy where two sperms fertilize an ‘empty’ egg that has no nucleus. It will have double the set of paternal DNA but no maternal DNA and the fetus does not form at all.
  • Partial molar pregnancy where two sperms will fertilize an egg and it will contain a normal set of maternal DNA but double the set of paternal DNA. The embryo develops partially but does not become a fetus.

In both cases, the egg will not survive.

GTN

A molar pregnancy rarely may lead to gestational trophoblastic neoplasia which is a form of cancer but it is curable. A persistent GTD, usually identified by high levels of HCG, is also referred to as GTN.

Symptoms

  • Extreme Nausea
  • Pain in the pelvic area
  • Irregular Bleeding in the first trimester.
  • Excessive enlargement of the uterus.
  • The HCG levels are very high as compared to a healthy pregnancy.

Causes

Factors that can increase the risks for GTD – maternal age (below 18 or over 45), history of miscarriage, previous molar pregnancy.

Diagnosis

  • They check your medical history
  • Pelvic scan
  • Pap test
  • Transvaginal ultrasound
  • Blood test
  • Urinalysis

Treatment

It is based on the type of GTD, your medical history, your tolerance and if you plan to get pregnant again. Treatment methods include-

  • Surgery to remove the tumor.
  • Dilation and curettage (D & C) to remove molar tissue from the uterus.
  • If found malignant, chemotherapy to treat cancerous cells.
  • Hysterectomy to remove the uterus.
  • Radiation

The only way one can prevent GTD is to not get pregnant. If you have had a molar pregnancy it does not affect your chances to be pregnant again but it is best that you consult with your doctor to mention when it is safe to do so as your HCG levels must fall back to normal.

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