Molar pregnancy is an abnormal development of the placenta
and is characterized by its abundant formations in the uterus in the form of
grapes. The incidence is reported as 1 in 1000 pregnancies. In those who have
previously had Molar pregnancy, the risk of re-Molar pregnancy increases by 10
times and increases to 1%.
The incidence increases with increasing maternal age. It is
more common in women with low socioeconomic level and malnutrition.
There are
two types of molar pregnancy:
A) Complete (full) Molar: Pregnancy consisted only of
placental tissues. There is no tissue belonging to the baby. This form is the
more common form of Molar pregnancy. Its symptoms appear in the early stages of
pregnancy.
B) Partial Molar: In addition to the abnormal placental
development, baby structures are also present. A normal egg cell is fertilized
with two sperms. A baby with genetically excess chromosomes is unlikely to
live, even though a baby has been formed.
Symptoms:
- The patient can have all the symptoms of pregnancy.
- Menstrual delay is the first finding.
- Molar pregnancy usually causes bleeding in the early
pregnancy period.
- Pregnancy nausea and vomiting is more severe. Because the
amount of B-HCG secreted in this disease is far above normal. Rarely, in the
early period, situations occur due to the secretion of other hormones such as
preeclampsia, hyperthyroidism, excessive hair growth.
- Some of the pregnant women apply with the complaint of
"dropping grape-like pieces".
- Due to the high B-HCG (a hormone released from the
placenta), some patients may develop cysts in both ovaries. If these cysts grow
and secrete hormones, symptoms such as pain and hairiness in the body may be
added.
- All symptoms are usually milder in the partial Molar and
give symptoms later.
Diagnosis:
The most important tool in diagnosis is ultrasonography. On
ultrasound, vesicles belonging to Molar pregnancy are arranged side by side and
form "grape view" in the uterus. In the examination, the uterus may
be larger than it should be according to the week of pregnancy. Higher than
100,000 HCG values support the diagnosis. The exact diagnosis is made by
pathological examination of the material received by curettage. In pathological
examination, chorion vul- lals in complete Mola are diffuse hydropic and are
surrounded by hyperplastic, often atypical trophoblasts, without fetal tissue.
In partial molar, normal chorion villi are observed in some areas, fetal tissue
is observed, hydropic changes are focal, hyperplasia is less observed in
surrounding trophoblasts, and atypia is not observed.
Treatment:
Before the treatment, blood tests are carried out, spreading
research is made to other organs. Lung film is taken.
Abortion is the main treatment method under general
anesthesia in hospital conditions.
Track:
Patients are monitored strictly due to the risk of recurrence
of Molar pregnancy. In the follow-up program, the patient should not become
pregnant for 1 year. For this purpose, birth control pills should be used, the
IUD is contraindicated. The natural elevation of HCG that occurs at the time of
conception disrupts the follow-up and a recurrence that may occur may be
overlooked. Weekly measurements are made initially until blood BHCG levels
return to normal. During three consecutive weekly follow-ups, weekly follow-ups
should be continued until BHCG becomes zero. After weekly follow-ups, it is
continued up to 1 year with monthly follow-ups.
If everything is normal after 1 year, the patient is allowed
to become pregnant.
Application
of Anti-D Immunglobulin:
Despite the absence of a complete Molar fetus, Anti-D
immunoglobulin should be applied to mothers whose blood group is negative,
since the trophoblastic tissue can produce Rh (D) antigen. If the mother blood
group is negative in partial Molar hydatidorm, Anti-D should be performed in
the same way.
Does Molar
pregnancy recur in subsequent pregnancies?
In the general population, Molar pregnancy is seen at a rate
of one thousandth of pregnancy. The probability of a subsequent pregnancy after
a Molar pregnancy is about one percent.
The risk of recurrence for the third time in those who have
had two Molar pregnancies is around 16-28%.
Pregnancy
and birth after molar pregnancy:
It was observed that patients with complete or partial Molar
pregnancy were able to conceive and have children at a high rate after
treatment. Patients who received chemotherapy after treatment also had a high
proportion of children. There was no increase in complications related to
pregnancy.
Postpartum placenta should be evaluated histopathologically
in patients who had previously had a molar pregnancy, and possible gestational
trophoblastic disease should be ruled out by looking at the B-HCG value 6 weeks
after birth.
GESTATIONAL
TROFOBLASTIC NEOPLASIA
Molar pregnancy can turn into a disease called Gestational
Trophoblastic Neoplasia (GTN). If blood BHCG levels do not decrease or remain
the same in the follow-up of Molar, or start to increase again after a while,
it suggests the possibility of developing GTN. GTN is a disease that can spread
to other parts of the body (metastasis) or recur in the uterus. GTN occurs in
50% of cases following Molar pregnancy, in 25% of cases, and in 25% of cases
following normal pregnancy.
It responds very well to chemotherapy. Sometimes other
treatments such as hysterectomy and intraarterial chemotherapy may be required.
The most commonly used chemotherapeutic agent is
methotrexate. In addition, actinomycin-D, etoposide, 5-Fluorouracil are other
agents used.
-ECTOPIC PREGNANCY
-HETEROTOPIC PREGNANCY
-SILENT MISCARRIAGE (MISSED MISCARRIAGE)
-MOLAR PREGNANCY
-OVARIAN PREGNANCY
-CERVICAL PREGNANCY
-CERVICAL INSUFFICIENCY
