Signs and Symptoms of A Molar Pregnancy

Signs and symptoms of a molar pregnancy

1. Normal first trimester symptoms
2. Persistent nausea and vomiting
3. Bleeding by 12th week (continuous or intermittent, usually light)
4. "Large for dates" are typical, although about 25 percent may be "small for dates"
5. No fetal heart tones or fetal movement
6. Hypertension may become a problem in the second trimester
7. Shortness of breath (late, life threatening indication of an embolism)
8. Enlarged, tender ovaries (ovarian cysts)
9. Passage of "grape-like" vesicles with bleeding

Diagnosis of a molar pregnancy is made by ultrasound and by elevated beta hCG levels. There is a rare risk (two percent) of choriocarcinoma (cancer) following molar pregnancy. Benign tumor formation may also occur.

Treatment involves evacuation, usually with suction curettage, of the vesicles within the uterus. Lab studies might include serial beta hCG levels, blood clotting studies, liver and thyroid profiles, hemoglobin, and chest X-ray.

Beta hCG levels are drawn every one to two weeks until resolved and then they may be done on a regular schedule for the year following the loss.

Because the risk of cancer needs to be fully evaluated, effective contraception should be used for one year following the pregnancy. Regular visits for a physical and pelvic exams are made until the uterus and ovaries are back to normal. Thereafter, they are generally done every three months for the next year.

In subsequent pregnancies, the woman may be at higher risk of another molar pregnancy, so she is followed closely with serial hCG levels and ultrasound.

Experiencing a molar pregnancy is extremely stressful for the woman, her partner and family. Not many people understand the physiology of such a pregnancy. It is generally best to tell loved ones that a miscarriage has occurred and that special followup lab work is necessary. When the pregnancy itself has been "ambiguous" and the life of the mother has been at risk, it may be harder to understand and disclose all of the details.

Ectopic Pregnancy

Ectopic Pregnancy

Ectopic pregnancy occurs whenever the blastocyst implants anywhere except in the endometrium lining the uterine cavity. Possible sites for ectopic pregnancy include the cervix, fallopian tubes, ovaries, and abdomen. Predisposing factors to ectopic pregnancy are given in this section. For a woman with a suspected ectopic pregnancy, the midwife should draw blood for a quantitative human chorionic gonadotropin, obtain an ultrasound, and notify the consulting physician. Early diagnosis and referral to the physician are critical. If a tubal pregnancy can be diagnosed before rupture, microsurgery or medical management with methotrexate is more likely to save the fallopian tube.

Source:

Helen Varney. Varney’s Midwifery. Jones & Bartlett Publishers, 1997.