Pregnancy & Baby 

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Molar pregnancy

A hydatidiform mole brings alarming talk of tumours and cancer. Dr Howard Lee explains the diagnosis, treatment and prognosis

It is a terrible shock when you go for your first ultrasound and instead of regular heartbeats showing up on the screen, you’re told that your baby has stopped growing and that you may have a ‘molar pregnancy’. But this is often how women discover that they’re suffering from this rare complication, which affects 1 in 1,000 pregnancies. It is not clear why hydatidiform moles develop in the womb, but we do know that a previous miscarriage doubles the chance and that the risk also increases with age.

What is a molar pregnancy?

It occurs when the developing tissue responsible for the placenta (afterbirth) shows an abnormal overgrowth and a hydatidiform mole develops. The placenta is made up of millions of cells called trophoblastic cells and this overgrowth is often referred to as ‘trophoblastic disease’.

The hydatidiform mole itself is usually harmless and a cancerous change is quite rare. However, if the condition is not treated, it can continue to grow, burying itself in the surrounding organs. It can also spread through the bloodstream to other parts of the body, including the lungs, liver, brain, spleen and kidneys.

Types of trophoblastic disease

Hydatidiform mole where the abnormal placental tissue growth is benign but capable of spreading if not treated.
There are two types:

• partial mole where only part of a normal placenta shows overgrowth – any baby that is present is not developing normally
• complete mole where the entire placenta, which is growing rapidly, is abnormal, and there is no baby present

Persistent trophoblastic disease where part of a previous mole remains after treatment. Even a tiny piece of mole in any part of the body can grow rapidly and cause problems.

Choriocarcinoma is a very rare cancer, which is curable. In this case, the placenta develops a malignancy, which can spread throughout the body. It can occur in a molar pregnancy, a miscarriage, an ectopic pregnancy, and even following an otherwise normal pregnancy.

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