Molar pregnancy: how to detect it?

Polar pregnancy is a very rare disease that is characterized by an abnormal development of the placenta. This is due to an abnormality at the time of fertilization. Young women and those over the age of 45 are the most at risk for molar pregnancy.

There are two types of molar pregnancy

The molar pregnancy can be complete or partial.
Complete molar pregnancy (or complete hydatidiform mole) is the result of fertilization between an egg without a nucleus (without genetic material) and one or two sperm. There is therefore no embryo developing, only the placenta which evolves in the form of cysts resembling a bunch of grapes.
Partial molar pregnancy (or partial hydatidiform mole) occurs when a normal egg has been fertilized by two sperms or an abnormal sperm. In this case, an embryo is formed but it is not viable.

In both cases, the placenta develops abnormally and in the absence of complete genetic material, the egg is not viable.

What are the symptoms of a molar pregnancy?

The most frequent signs are:

• unexplained blood loss during the first trimester of pregnancy.
• symptoms of pregnancy (nausea, swelling of the lower abdomen, abdominal pain) worsened.
• a miscarriage. The diagnosis of polar pregnancy can only be made after analysis of the curettage product (if the miscarriage did not allow the uterus to naturally expel the pregnancy). As a reminder, miscarriages are generally due to chromosomal abnormalities.

A complete molar pregnancy is asymptomatic in 40% of the cases. Without symptoms, the diagnosis can only be made during an ultrasound.

What is the follow-up of a molar pregnancy?

A molar pregnancy does not progress normally. The product of fertilization (embryo, placenta) must be evacuated from the uterus as soon as possible to avoid any complications. Evacuation is by uterine aspiration under ultrasound control. The pregnancy product is then analyzed to identify the type of mole.
Patients should have an ultrasound within 15 days of aspiration to check that there is no residue of the pregnancy left in the womb. At the same time, they should take a blood test for the hormone beta-hCG (hormone that proves the presence of a pregnancy) until the level is negative (a sign that the pregnancy has been terminated). “This monitoring is initially weekly then monthly once the negativation is obtained”, Indicates the High Authority of Health (HAS). It is estimated that there is negativation of the rate after 3 successive negative rates. Then, follow-up continues for 6 months in the case of partial hydatidiform mole, for 12 months in the case of complete hydatidiform mole.

Molar pregnancies are mostly benign. In very rare cases (around 180 cases per year in France), it can be invasive, we then speak of choriocarcinoma. A form of cancer that is part of gestational trophoblastic tumors and that can be treated well if diagnosed early. A tumor is suspected when the level of beta-hCG increases again or stagnates even after the initial aspiration of the mole. Hence the importance of regular blood tests.

When to consider a new pregnancy?

A new pregnancy can be considered:

• after 6 months of negative hCG assays for partial hydatidiform moles and complete hydatidiform moles (if the negativation was done in 8 weeks or less)
• after 12 months of negative hCG assays for the other complete hydatidiform moles.

In the event of a gestational trophoblastic tumor, treatment with chemotherapy is implemented. It does not harm fertility. Pregnancy is quite possible after the end of the monitoring period.

Sources:

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