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molar pregnancy

Grapes Are Inside My Uterus and Not a Baby! It Is Hydatidiform Mole.

You are pregnant with all its symptoms and signs….but an ultrasonography done following one episode of bleeding per vagina revealed there is no fetus inside. The uterus is full of vesicles like bunch of grapes!! This condition occurs in one out of 1200 pregnancies where the placenta changes into grape like structutes.There is no fetus inside and if present, it is small and malformed.

There will be bleeding per vagina, sometimes with passage of grape-like vesicles in a four months pregnant lady

Clinically this condition presents as sudden bleeding per vagina mixed with vesicles following a period of missed period along with pain abdomen. There may be increased nausea and vomiting in her early pregnancy-period. Size of the pregnant uterus is often more than the period of amenorrhea. Features of thyroid disorders are often seen as this grapes sometime secret thyroid hormone.

Diagnosis is confirmed by ultrasonography of uterus and increased hormone beta-hCG level in blood.

Ultrasonography shows moles inside uterus, sometimes along with enlarged ovaries. There will be no fetus or fetal heart sounds. Sometimes a small or malformed fetus is found surrounded by grapes. This condition is called partial molar pregnancy. Level of beta-hCG, a pregnancy hormone, will be very high in contrast to normal pregnancy.

Urgent Evacuation of Uterus by Suction Is Mandatory

This growing mole can cause massive vaginal bleeding, even can perforate uterus. It can even endanger life by transporting to lungs and other organs through blood. So you need an urgent management of this condition to avoid complications. Gentle suction through vagina is the mode for evacuation. Risk of bleeding is also there while doing the evacuation process. Chance of infection is also there.

Though this condition is benign—3-4% cases turn cancerous called choriocarcinoma

This is a benign disease. But rarely might it turn malignant. In 1-4% cases recurrence also occur in subsequent pregnancy.   So be particular for a methodical follow up.

Who are the high-risk candidates for developing cancer following H-mole?

They are the women who have any or multiple risk factors mentioned below.

• Age more than 45 years
• Three or more previous birth
• Previous history of molar-pregnancy
• Uterus more than 20 weeks size
• Initial high serum hCG> 1,00000 mIU/ml

Follow-Up Visit Is Mandatory

Frequent follow up with general work out along with three weekly blood beta-hCG estimation is mandatory to diagnose persistence of disease or to rule out any malignant transformation. Look for any of these symptoms/signs in post-abortal period

• Irregular persistent bleeding per vagina
• Growth or mass around genitalia
• Persistent pain abdomen
• Respiratory difficulty

Often a follow up chest x-ray is recommended to find any lung metastasis.

Decision regarding timing of next pregnancy is vital

A second pregnancy within a short interval following a molar is catastrophic. You have to wait for one year or six months following normalization of beta-hCG levels, which one is later. Otherwise a chance of recurrence is there.

Low-dose combined contraceptive pills can be used meantime

Contraception is needed following suction-evacuation and low dose pills can be opted for this. Intrauterine devices could not be recommended for fear of perforation of soft uterus.