Molar Pregnancy (Gestational Trophoblastic Disease)

A molar pregnancy, also called a hydatidiform mole or gestational trophoblastic disease, is a pregnancy in which placental tissue overgrows into fluid-filled, grape-like vesicles and there is no viable fetus. A complete mole has no fetal tissue and carries the higher risk of turning into cancer; a partial mole has some fetal tissue that cannot survive and a much lower risk. The classic picture is vaginal bleeding in the first or early second trimester, often dark brown, with a uterus larger than the dates, an hCG level far higher than expected, severe nausea and vomiting, and sometimes preeclampsia before 20 weeks. There are no fetal heart tones, and the ultrasound shows a snowstorm pattern. Treatment is prompt suction curettage, watching closely for hemorrhage, with Rh immune globulin for a patient who is Rh-negative. Then hCG levels are drawn until undetectable and monitored for months. Teach reliable contraception for about six to twelve months, because a new pregnancy would hide a rising hCG, the first sign of gestational trophoblastic neoplasia. Offer grief support throughout.