Understanding Molar Pregnancy: Causes, Symptoms & Treatment

Introduction

Hello, I am Dr. Madhu Juneja, Director of Momstory by Sahyadri Hospitals, Hadapsar, Pune.
Today, I’ll be sharing insights on a rare but significant pregnancy complication — Molar Pregnancy, also known as Vesicular Mole or in layman’s terms, “Grapes Pregnancy.”

Let’s understand why it occurs, its symptoms, possible complications, and treatment options available.

What Is a Molar Pregnancy?

A molar pregnancy happens due to an abnormal fertilization process where the growth of placental tissue becomes uncontrolled.
Instead of forming a normal embryo, the tissue inside the uterus develops into fluid-filled cysts, giving a grape-like appearance.

This condition is essentially a placental abnormality caused by partial degeneration and excessive proliferation of the chorionic villi — the structures that normally help form the placenta.

Types of Molar Pregnancy

There are two main types:

1. Complete Molar Pregnancy

• No fetus or normal placental tissue forms.

• Only abnormal placental growth is seen.

2. Partial (Incomplete) Molar Pregnancy

• Some fetal tissue may be present, but it develops abnormally.

• The placenta shows both normal and cystic (grape-like) areas.

Why Does Molar Pregnancy Occur?

A molar pregnancy occurs when the egg and sperm fuse abnormally, leading to an incorrect number or combination of chromosomes.

It is seen more frequently in:

• Teenage mothers and women over 35 years

• Women with blood group AB positive

• Those from Asian populations, especially India, Japan, and the Philippines

In India, the incidence is approximately 1 in every 400 pregnancies.

Symptoms of Molar Pregnancy

Common signs and symptoms include:

• Vaginal bleeding during early pregnancy

• Abdominal pain or discomfort

• Expulsion of grape-like cysts through the vagina

• Rapidly enlarging uterus disproportionate to gestational age

• Absence of fetal heartbeat or movement

• Breathlessness or thyroid-related symptoms (in rare cases)

If untreated, the molar tissue may spread beyond the uterus, causing breathing issues and other systemic complications.

Diagnosis of Molar Pregnancy

A molar pregnancy can be diagnosed through:

1. Ultrasound (Sonography)

• Shows a “snowstorm appearance” — a classic sign of molar pregnancy.

2. Blood Tests

• Beta-hCG levels are abnormally high.

• Additional tests include liver, kidney, and thyroid function tests to assess overall health.

3. X-Ray (if required)

• May reveal the spread of molar tissue, though CT or MRI scans are rarely needed for diagnosis.

Complications of Molar Pregnancy

If not diagnosed early, molar pregnancy can cause:

• Severe vaginal bleeding (hemorrhage)

• Infection (sepsis)

• Uterine perforation due to excessive tissue growth

• Pulmonary insufficiency or breathlessness

• ICU admission in severe cases

In about 2–10% of cases, the molar tissue may become cancerous, leading to a rare condition known as Choriocarcinoma, which requires chemotherapy.

Treatment and Management

1. Early Diagnosis Is Key

Timely detection offers the best outcomes. Once diagnosed via ultrasound, the treatment involves:

2. Dilation and Curettage (D&C)

A minor surgical procedure to remove the abnormal tissue from the uterus. During the process, an oxytocin drip is administered to help the uterus contract and expel the tissue completely.

3. Hysterectomy (in rare cases)

If the molar tissue persists or the patient doesn’t wish for future pregnancies, the uterus may be surgically removed.

4. Follow-Up and Monitoring

• Beta-hCG blood tests are performed weekly until levels return to zero (usually within 6–8 weeks).

• Then monthly follow-ups continue for 6 months to 1 year.

• During this time, no pregnancy should be attempted, as close monitoring is crucial to rule out recurrence.

If the condition shows signs of malignancy, chemotherapy may be recommended to prevent cancer spread and protect the patient’s health.

Prognosis and Future Pregnancy

With early detection and proper follow-up, most women recover completely and can have healthy pregnancies in the future.
However, strict adherence to follow-up schedules and medical advice is essential to ensure safety.

Conclusion

A molar pregnancy can be emotionally and physically challenging, but with timely diagnosis, expert medical care, and consistent follow-up, it is completely treatable.

If you experience abnormal bleeding, pain, or absence of fetal movement, consult your gynecologist immediately.

For expert guidance and personalized care, visit Dr. Madhu Juneja at Momstory by Sahyadri Hospitals, Hadapsar, available daily from 10 AM to 1 PM (by prior appointment).