Read about Sunita’s case ? from discovery to treatment and results
Finding out that you’re pregnant comes with its fair share of surprises and shocks, but what Sunita (name changed) was not expecting was feelings of confusion and frustration.
Sunita was a 26-year-old woman who had been married for two years when she came in for a pregnancy confirmation. This was her first pregnancy, and she had no prior pregnancies, abortions, or medical complications.
At roughly 8 weeks, the first scans revealed no evidence of gastrointestinal sac, foetal pole, or cardiac activity, but grape-like clusters of blood vessels and tissue, confirming a molar pregnancy. After further evaluation, the ? – hCG levels were found to be significantly higher than normal.
Sunita was counseled and scheduled for a dilatation and suction evacuation (D&E) under short general anesthesia after a complete blood analysis and chest x-ray.
|? – hCG ? The human chorionic gonadotropin (hCG) level in the blood is measured with the ? – hCG test. This hormone is produced as early as 10 days after conception, and a level that is higher than normal can confirm pregnancy.|
D&E ? It is a molar pregnancy surgery done under general anaesthesia in which the surgeon opens up (dilates) the cervix (womb entrance) and gently suctions out as much molar tissue as possible.
She was then discharged with instructions to return weekly for ? – hCG monitoring, until the levels were zero, and was to have a USG follow-up after a week.
The follow-up USG showed no retained products of conception(RPOC) and the ? -hCG had reduced to 50% in the first week. The patient was observed through follow up appointments.
|USG (Ultrasound Sonography Test) ? A procedure that uses high-frequency sound waves to scan the internal organs of the body usually a pregnant woman’s belly and pelvic cavity, the reproductive system, and the foetus, to create a picture (sonogram) of the baby and placenta.|
RPOC ? The foetal or placental tissue that remains in your uterus after pregnancy is referred to as retained products of conception (RPOC).
What is a molar pregnancy? ? An overview
Molar pregnancy, also known as hydatidiform mole, is a rare pregnancy complication marked by abnormal growth of the cells (trophoblasts) that develop into the placenta. There are two types of molar pregnancies ? complete and partial.
In a complete molar pregnancy, the sperm fertilizes with an empty egg causing the tissue to grow and form grape-like clusters. These clusters trigger hCG levels and feed on them. These tissues can sometimes grow into a cancerous malignancy known as Choriocarcinoma.
In a partial pregnancy, two sperm fertilize a single egg. In normal cases, this would lead to the formation of twins, but in molar pregnancies, the fetus has too many chromosomes and eventually dies. Although there have been cases where one of the fetuses is viable and the other molar, leaving the mothers to decide to terminate the pregnancy or risk cancer.
- Its incidence in India has been estimated at around 1 in 150-160 pregnancies
- 80% of molar pregnancies resolve on treatment and adequate follow-ups
- 15% persists as a residual mole, requiring further treatment
- 5% leads to molar pregnancy cancer, otherwise known as Choriocarcinoma
Molar pregnancy diagnosis
The signs and symptoms of molar pregnancy are frequently confused with those of a miscarriage or an ectopic pregnancy. But some specific signs, besides high levels of hCG, that indicate molar pregnancy include ?
- A history of missed menstruation with a positive urine pregnancy test (UPT)
- Severe nausea and vomiting during pregnancy (Hyperemesis gravidarum)
- Passage of grape-like clusters with bleeding from the vagina
- Thyrotoxicosis (excess of thyroid hormone in your body) causing pre-eclampsia (pregnancy complication causing high blood pressure) in advanced pregnancy
Evaluation and treatment
The following is the typical procedure followed in the evaluation and treatment of a molar pregnancy
- A baseline for the hCG level is set after the first USG test
- After thorough investigation and counseling, the patient is posted for surgical exploration under general anesthesia
- Surgical exploration is followed by USG to confirm complete evacuation
- Weekly hCG tests are required for 6-8 weeks till it becomes negative and then monthly follow-up is needed for the next 8-12 months
- Patients are advised to avoid pregnancies for a period of 1 year by using oral contraceptives or barrier contraception. Copper-t is to be avoided.
- Prophylactic treatments are recommended in high-risk pregnancies and for patients who cannot come for follow-ups.
In Asian women, 1 in 150 pregnant women may have a molar pregnancy. Like in Sunita’s case, early diagnosis is very crucial in complete management and cure from the complications that molar pregnancies can cause. In recent years a 100% cure rate is being achieved and successful pregnancies are established after treatment.
Hence, make sure you book your antenatal appointments and check-ups early to ensure a healthy pregnancy.
To consult the top gynecologists in Bangalore and Chandigarh, reach out to Ayu Health Hospitals. With the best staff, technology, and care, we assure quality treatment for all our patients. Visit our website to book an appointment or call us at +91 – 6366 100 800 for a consultation.