A molar pregnancy (hydatidiform mole) is an abnormal pregnancy in which placental tissue grows into fluid-filled cysts instead of a normal embryo. It is a form of gestational trophoblastic disease, and close hCG follow-up after treatment detects the rare progression to cancer.
Key symptoms
- Vaginal bleeding in the first trimester
- Severe nausea and vomiting
- Pelvic pressure or passing grape-like tissue
- Symptoms of hyperthyroidism or early preeclampsia
What you find on exam
- Uterus larger than expected for dates
- No fetal heart tones
- Blood pressure, sometimes high before 20 weeks
- Enlarged ovaries from theca lutein cysts
Tests
- Quantitative hCG, often much higher than expected
- Pelvic ultrasound: snowstorm pattern or cystic placenta
- Blood count, blood type and Rh, thyroid and liver tests
- Chest X-ray before treatment
- Pathology of the removed tissue
Treatment basics
- Suction dilation and curettage to empty the uterus
- Rh immune globulin if Rh negative
- Weekly hCG until normal, then monthly follow-up
- Reliable contraception during follow-up
- Chemotherapy such as methotrexate if hCG plateaus or rises
Red flags
- Heavy vaginal bleeding or signs of shock
- Severe high blood pressure, shortness of breath or thyroid storm
- hCG that rises or stops falling after evacuation
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.