Molar Pregnancy

A molar pregnancy, or hydatidiform mole, is uncommon. A gestational trophoblastic disease (GTD), it occurs predominantly in older women. In the United States, molar pregnancy occurs in about 1 in 1800 pregnancies (Grimes, 1984). Molar pregnancy can be classified as complete or incomplete, which are two distinct entities etiologically and pathologically. A complete or hydatidiform mole has no fetal components, consists entirely of hydropic placental villi, is frequently associated with medical complications, and has a 15% to 20% risk of GTD (Jones, 1987). In an incomplete mole, a fetus, usually abnormal, is often present. The placenta may be hydropic or small, and there is a 5% to 10% risk of GTD.

A hydatidiform mole is most often diagnosed in the first trimester because of symptoms of excessive nausea and vomiting, vaginal bleeding, uterine size larger than expected, and sonographic findings of no fetus but a large placenta with numerous small cysts. These findings should prompt quantitative hCG evaluation, which is often elevated. Evacuation of the uterus with careful attention to levels of hCG poste-vacuation is important to detect GTD, usually invasive mole, occasionally choriocarcinoma. Pregnancy is avoided for 1 year after a complete mole.

An incomplete mole is most often diagnosed in the second trimester and occasionally the third trimester. There may be an abnormal placenta, fetal growth and structural abnormalities, or signs and symptoms of preeclampsia.

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