Molar Pregnancy (Grape Pregnancy) (Hydatidiform Mole)

What is a molar pregnancy?

This abnormal form of pregnancy, referred to in medical terms as “Molar Pregnancy” or “Hydatidiform Mole” and in the community as “Grape Pregnancy”, is a special condition within the group of “Gestational Trophoblastic Diseases”. Molar pregnancy occurs in relation to the abnormal development of the placenta. It contains numerous formations resembling grapes in the uterus. The probability of encountering this condition is estimated to be 1 in 1000 pregnancies. In expectant mothers who have had a previous history of molar pregnancy, the probability of encountering molar pregnancy again increases by almost 10 times and rises to 1%. It also increases in direct proportion to the mother’s age.

Who is at higher risk of developing it?

• It is seen much more in pregnancies under the age of 20 and over the age of 35. The age of the father is not important.
• Women with a history of previous pregnancy.
• Low socioeconomic status women
• Women with malnutrition and low protein intake
• Women who use birth control pills
• Pregnancies where the mother has blood group “A” and the father has blood group “0” or the father has blood group “A” and the mother has blood group “0”.
• Smoking
• The white race
• Genetic factors
• There is an increase in complications in grape pregnancies in women exposed to ionizing radiation.
• One of the most important and effective risk factors for the occurrence of molar pregnancy is maternal age.

What are the symptoms?

Vaginal bleeding

In almost all cases, a complaint is definitely encountered. In a pregnant patient, it should definitely be considered together with other causes. It can be dark brown or light red.

Uterus size is larger than normal

This symptom is found in almost 50% of cases. The uterus is significantly larger than it should be during normal pregnancy. There is a noticeable increase in pregnancy cells and an increase in the size of the uterus, associated with bleeding areas. Apart from these symptoms;

The baby’s heartbeat cannot be heard

• In about 25% of cases, extreme nausea, vomiting and extreme pregnancy symptoms are seen.
• The condition called pregnancy poisoning occurs before the 24th week of pregnancy.
• The grape-like sacs that give the disease its name come out of the vagina along with discharge or bleeding.
• Overactivity of the thyroid glands (seen in 20% of cases)
• Blood clot in the lungs and sudden onset of shortness of breath (may be seen in 2-3% of patients)
• Large cysts (theca-lutein cysts) may develop in the ovary due to pregnancy and the excessively increased pregnancy hormone in the disease.
• If these cysts cause bleeding or torsion of the ovary, they may cause sudden onset of severe abdominal pain.

How is the diagnosis made?

When diagnosing molar pregnancies, the diagnosis is certain when blood tests and ultrasonographic evaluations are performed on patients who have the symptoms just mentioned.

B-hCG test

It is a substance secreted during pregnancy. In normal pregnancies, B-hCG is seen to increase to 50 thousand to 100 thousand levels until the 12th week of pregnancy. However, this value begins to decrease in later periods. If the B-hCG value is detected much higher than these values in the expectant mother, it should be considered in terms of disease diagnosis.

Ultrasonography

With the detection of characteristic ultrasonographic images for this disease, the necessary diagnosis can be made very easily. Transvaginal ultrasonography has a very important place in early diagnosis.

Is it possible to treat molar pregnancy?

Yes, it is possible. The treatment is to evacuate the pregnancy in the mother-to-be by curettage. However, the patient’s current complaints, the rate of bleeding, the woman’s age, and her desire for a child should be taken into consideration when the treatment is performed.

If the patient comes to the hospital with a portion of the grape pregnancy expelled from her body, and if it is also diagnosed that her uterus is small and hard, immediate pregnancy evacuation can be performed with a sharp curettage. However, if the uterus is larger and looser, what needs to be done is a vacuum curettage, and then a sharp curettage. With these methods, the entire grape pregnancy is evacuated from the uterus.

In cases where the diagnosis is made in cases that have not had a miscarriage before and have no bleeding, the pregnancy is terminated as soon as possible, taking into account the general health condition of the patient. In cases such as excessive thyroid function, high blood pressure, rapid or slow blood loss, anemia, low body fluids and respiratory distress related to grape pregnancy, efforts are made to correct them with appropriate treatment. If the patient does not want to have children, hysterectomy is used as an effective treatment method.

To summarize the treatment methods that can be performed;

• Aspiration curettage (Only curettage is performed at home, this is the most commonly used method.)
• Agents such as oxytocin and prostaglandins that help contract the uterus
• Hysterotomy (the uterus is surgically opened and emptied)
• It is a hysterectomy (a type of surgery in which the uterus is removed).

How to control and monitor after the discharge process?

• Following evacuation of molar pregnancy, the generally accepted control and follow-up period is 1 year.
• The B-hCG value must be reset to zero after treatment. Beta-hCG blood test should be performed once a week until a negative Beta-hCG value is obtained 3 times in a row.
• In the future, the follow-up that needs to be done is once a month. Previously, every 2 weeks, after recovery, a gynecological examination must be done every 3 months for a period of 1 year.
• If, during the control of the B-hCG test value, an increase rather than a decrease in the current values is detected, then chemotherapy can be added to the treatment.

Is there a need for protection after the evacuation process?

After a negative B-hCG test, patients are advised not to become pregnant for 1 year. The use of intrauterine devices (IUDs) is also not recommended due to the risk of uterine perforation and bleeding. For this reason, women should use birth control pills as a form of protection.

Does Molar Pregnancy affect subsequent pregnancies?

A history of previous grape pregnancy increases the risk of developing grape pregnancy. In women who have had grape pregnancy once, the risk of recurrence of the disease in future pregnancies increases. In women who have had grape pregnancy, the probability of developing grape pregnancy in their next pregnancy is approximately 2%. At the same time, as the number of grape pregnancies increases, the risk increases proportionally. However, despite these, it does not increase the probability of disability in the pregnancy that will occur.

What can be done for early diagnosis?

• Under normal conditions, in all pregnancies, regular ultrasounds should be performed between the 5th and 6th weeks of pregnancy to determine whether the pregnancy is present, to detect the baby’s heartbeat and to determine its location.
• During this examination, if there is a grape pregnancy, it is detected immediately. In addition to this, when the pregnancy test beta hcg is performed, a value much higher than the expected value is encountered.
• The most important thing here is that expectant mothers who have had a grape pregnancy before should consult a doctor at an earlier stage, as there is a risk of recurrence in their next pregnancy.