Molar pregnancy is a gestational trophoblastic disease (GTD) where abnormal trophoblastic proliferation leads to the formation of a grape-like mass in the uterus instead of a normal fetus.
Types of Molar Pregnancy
- Complete Mole
- Partial Mole
1. Complete Molar Pregnancy
Etiology & Pathophysiology:
- Fertilization of an empty ovum (no maternal DNA) by:
- Single sperm that duplicates (46, XX – Most common).
- Two sperms fertilizing the empty ovum (46, XY – Less common).
- No fetal parts, only trophoblastic tissue.
Clinical Features:
- Excessive nausea & vomiting (Hyperemesis Gravidarum).
- Uterus larger than gestational age.
- Painless vaginal bleeding ("prune juice" discharge).
- Passage of grape-like vesicles per vagina.
Diagnosis:
- Ultrasound:
- "Snowstorm appearance" with no fetal parts.
- Serum β-hCG:
- Markedly elevated (>100,000 mIU/mL).
Complications:
- Persistent GTD → Choriocarcinoma risk.
- Hyperthyroidism (hCG has TSH-like activity).
- Theca lutein cysts (Ovarian cysts due to high hCG).
2. Partial Molar Pregnancy
Etiology & Pathophysiology:
- Fertilization of a normal ovum by two sperms → Triploidy (69 chromosomes, 69 XXX/XXY/XYY).
- Contains some fetal parts but is non-viable.
Clinical Features:
- Milder symptoms compared to complete mole.
- Vaginal bleeding with smaller uterus.
- Fetus may be present but malformed.
Diagnosis:
- Ultrasound:
- "Swiss cheese pattern" with fetal parts.
- Serum β-hCG:
- Moderately elevated.
Complications:
- Lower risk of persistent GTD compared to complete mole.
Management of Molar Pregnancy
1. Evacuation of Molar Tissue:
- Suction evacuation & curettage (Preferred method).
- Hysterectomy (For older women who do not want future pregnancies).
2. Post-Evacuation Monitoring:
- Serum β-hCG weekly until undetectable.
- Monthly β-hCG for 6 months.
- Avoid pregnancy for at least 1 year.
3. Treatment of Complications:
- If β-hCG remains elevated or rises, consider Persistent GTD or Choriocarcinoma.
- Chemotherapy (Methotrexate or Actinomycin D) if malignant transformation occurs.
Prognosis & Follow-Up
- Good prognosis if treated early.
- Malignant transformation risk:
- Complete Mole: 15–20% risk of choriocarcinoma.
- Partial Mole: <5% risk.
Comparison of Complete vs. Partial Mole
|
Feature |
Complete Mole |
Partial Mole |
|
Karyotype |
46, XX or 46, XY (Paternal) |
69, XXX/XXY/XYY (Triploidy) |
|
Fetal Tissue |
Absent |
Present (but non-viable) |
|
Uterus Size |
Larger than gestational age |
Normal or slightly enlarged |
|
β-hCG Levels |
Markedly elevated |
Mildly elevated |
|
Ultrasound Findings |
Snowstorm pattern, no fetal parts |
Swiss cheese pattern, fetal parts present |
|
Malignant Potential |
15–20% (higher risk) |
<5% |
Summary of Molar Pregnancy
|
Feature |
Key Points |
|
Definition |
Abnormal trophoblastic proliferation forming a mass
instead of a fetus |
|
Types |
Complete (46, XX/XY, no fetus), Partial (Triploid,
some fetal tissue) |
|
Symptoms |
Vaginal bleeding, enlarged uterus, excessive
vomiting |
|
Diagnosis |
Snowstorm appearance on ultrasound, high β-hCG |
|
Management |
Suction evacuation, β-hCG monitoring, avoid
pregnancy for 1 year |
|
Complications |
Choriocarcinoma, Hyperthyroidism, Theca lutein cysts |
1. Thuja Occidentalis
- Abnormal uterine enlargement with excessive hCG.
- History of warts, tumors, or abnormal tissue growth.
- Profuse vaginal discharge with a fishy smell.
- Headaches, dizziness, and weakness due to abnormal hormone levels.
- General aggravation from cold and damp weather.
2. Hydrastis Canadensis
- Thick, sticky, yellowish vaginal discharge.
- Persistent uterine bleeding after molar pregnancy removal.
- Weakness and extreme fatigue.
- Dragging pain in the lower abdomen.
- Craving for warm drinks, with a coated yellow tongue.
3. Sabina Officinalis
- Profuse, bright red vaginal bleeding with dark clots.
- Severe cramping pain in the lower abdomen, radiating to the thighs.
- Worse from the slightest motion, better with rest.
- A history of miscarriage or abnormal pregnancy growth.
- Uterine pain extending to the lower back.
4. Secale Cornutum
- Thin, dark, persistent vaginal bleeding.
- Burning sensation in the uterus.
- Excessive weakness and trembling due to blood loss.
- Aggravation from warmth, better with cold applications.
- More common in women with a history of prolonged, exhausting labor.
5. Kali Carb
- History of multiple pregnancy losses.
- Intense back pain and a weak, dragging sensation in the pelvis.
- Swelling and bloating in the lower abdomen.
- Extreme weakness, worse at night.
- Cold and damp aggravate all symptoms
- Thuja Occidentalis: Best for abnormal tissue growth and post-molar pregnancy care.
- Hydrastis Canadensis: Helps with excessive vaginal discharge and weak uterine tone.
- Sabina Officinalis: Used for heavy bleeding and post-molar hemorrhage.
- Secale Cornutum: Manages prolonged, dark bleeding with uterine atony.
- Kali Carb: Strengthens the uterus, prevents recurrent pregnancy loss.
Important Note:
- Molar pregnancy requires medical supervision and surgical evacuation.
- Homeopathy can be used as supportive treatment to aid recovery and prevent complications.
- Regular follow-up is essential to monitor hCG levels and rule out GTD (Gestational Trophoblastic Disease).
