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Molar Pregnancy

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Treatment

If the pregnancy has not ended on its own a suction D & C is usually used to evacuate the mole form the uterus. If a woman does not wish to continue with childbearing sometimes a hysterectomy is offered. Induction of labor is not recommended due to increased risks of hemorrhage.

On going treatment includes hCG levels to be taken several times a week, then weekly, until they are "normal" for three weeks. Then you will be tested monthly for six months, and every two months until a total of one year has passed. Pelvic exams should be done too. A rising level of hCG and an enlarging uterus could indicate a choriocarcinoma, an uncommon but treatable form of cancer associated with pregnancy. This occurs in about 1/40,000 cases.

Pregnancy should be avoided for the period of one year. Any method of birth control, with the exception of an intrauterine device, is acceptable.

If you are Rh negative, then you will also receive the Rhogam shot.

Gestational Throphoblastic Disease (GTD) & Neoplasia (GTN)

This encompasses a range of problems that arise from a placental trophoblast. GTN refers to persistent tissue found in follow up to a molar pregnancy that is assumed to be malignant.

GTN is one of the most curable cancers in the gynecology. This is a change from earlier years because of the increased number of treatments, personalized care, it's more easily detected, and its extremely sensitive to chemotherapy.

There are two groups, nonmesastatic and metastatic, meaning the the disease has spread to other parts of the body, most frequently the liver and the brain. If you do not have brain or liver involvement your chances of recovery are nearly 100%, you are in the low risk group. Metastasis in either of the two areas indicate that you are in the high risk group.

Only 15-30% of women with a molar pregnancy will need further treatment. The main sign that this might be necessary would be continued bleeding after a D & C. Although other signs include abdominal pain, ovarian enlargement, and signs of a metastasis include pulmonary symptoms (coughing, etc.).

Methotrexate can also be used to help excavate the uterus. (This is an injection that causes the tissues to die and be discharged from the vagina.)

Emotional Health

Losing a pregnancy at any stage can be hard, and even when there may technically be no baby to grieve due to the reactions of the cells involved. This means that there will have to be a healing time for all involved and the stages of grief will be experienced, though not necessarily in order or at the same time as your partner.

What makes this type of loss different from a "normal miscarriage" or loss is that you have the added concern of the mother's continued health, including the risk of cancer.

While the risks of a molar pregnancy repeating itself are very small, it is something that most couples will think about prior to conceiving again.

The time to wait for another conception is also longer than a standard waiting time after a miscarriage. This can add pressure and heart ache.

Counseling, support groups, journaling, anything you can do to get your emotions out are great. Look for local resources as well as resources online.

Attempting Pregnancy Again

Do you or don't you? This is not an easy question.

If you've previously had a molar pregnancy without complications, your risk of having another molar pregnancy are about 1-2%. These odds are less than having a second ectopic pregnancy (7-25%), so in that respect the answer is good.

Medically it will depend on many factors. So couples will choose to have genetic counseling prior to conceiving again. In the end it's up to you and your partner if you wish to try again.

Sources:

Choriocarcinoma. Pub Med Health. 2010. Last accessed on 5/15/11 at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002465/

Obstetrics: Normal and Problem Pregnancies. Gabbe, S, Niebyl, J, Simpson, JL. Fifth Edition. 2007

OB/GYN Secrets, 2nd Edition. Frederickson,HL & Wilkins-Haug, L. 1997.

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