What is it about ?
Trophoblastic disease or molar pregnancy is a disease of the placenta. Trophoblastic disease can be complete or partial. In both cases, fertilization took place.
In case of complete molar pregnancy, the man’s sperm fertilized an egg from the woman that does not contain genetic material (empty egg). The 46 chromosomes present after this fusion all come from the father. This genetic defect prevents the development of a fetus. THE’ultrasound shows the placenta filled with vesicles that look like a bunch of grapes.
In case of partial molar pregnancy, the genetic material does indeed come partly from the father and partly from the mother, but, due to a bad fusion of the sperm and the ovum, there are 69 chromosomes instead of 46. An embryo can form, but it will present severe deformities and will not be viable.
It is important to treat trophoblastic disease and to ensure that all residues of the diseased placenta are removed from the uterus. Without treatment, the diseased placenta can implant in the lining of the uterus and develop into placental cancer. This risk is higher in the case of a complete molar pregnancy.
In whom and how often do they occur?
Trophoblastic disease is much more prevalent in Asia and Africa than in Western countries.
The risk is higher in women under 20 and in those over 40.
The risk is higher if the woman has already had a molar pregnancy.
How to recognize it?
This placental disease is usually manifested by vaginal bleeding in early pregnancy. If a woman has bleeding for an unusually long time after pregnancy or miscarriage, trophoblastic disease should be considered.
How is the diagnosis made?
If molar pregnancy is suspected, a ultrasound (vaginal) uterus should be performed, as well as a blood level measurement of HCG (chorionic gonadotropin), the hormone produced during pregnancy.
In the event of a complete molar pregnancy, the ultrasound will show a characteristic “snowstorm” of the disease. In partial molar pregnancy, the picture is that of a miscarriage.
In a complete molar pregnancy, the level of HCG is significantly higher than in a normal pregnancy, which can lead to more severe vomiting than in a normal pregnancy. In a partial molar pregnancy, the level of HCG may be normal. The level of HCG is also increased in case of cancer of the placenta.
What can you do ?
In case of vaginal bleeding in early pregnancy, contact a doctor. A ultrasound or a control of the level of HCG can optionally be programmed.
What can the doctor do?
A molar pregnancy must be terminated. The method used is most often suction curettage: this removes the inner layer of the uterus, as well as the affected placenta and possibly the embryo. After a spontaneous miscarriage, suction curettage is also sometimes used to remove the remains of the diseased placenta. Sometimes it is recommended to remove the uterus.
After treatment, the HCG level is monitored to make sure it is falling as expected. If the level does not decrease enough, it may indicate the presence of residual tissue or metastases. If metastases occur, which mainly develop in the lungs, liver, brain and vagina, treatment with chemotherapy should be started. The effect of the treatment is checked by monitoring the level of HCG.
In a future pregnancy, an ultrasound should be done early because of the increased risk of molar pregnancy. After childbirth, the placenta should be carefully examined. We will monitor the level of HCG to check that it decreases well after the pregnancy.
The prognosis is good: over 85% of women are still alive after five years.
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