A molar-whooza-what’s that now?

When I got a call from my consultant to say that my lab results had come back from the second D&C and they showed I’d had a molar pregnancy, my reaction was something along the lines of the title on this post.  Having never heard of such I thing I turned straight to the one resource you should never use in health-related situations – Google.  Where I took one look at the word ‘cancer’ and promptly freaked right out.

Actually, it turns out that molar pregnancy (also referred to as hydatidiform mole or gestational trophoblastic disease) is more common than you might think – one in 1200 pregnancies have this little-known complication.  There are two types of molar – complete and partial – and I was diagnosed with a partial mole which is more common.  A complete mole occurs when one sperm fertilises an egg as normal, but the maternal chromosomes are lost and the paternal ones double up.  In this case no foetus develops and the whole placenta is abnormal, appearing as a mass of cysts a bit like a bunch of grapes.  In a partial molar pregnancy, two sperm fertilise the same egg which means that three sets of chromosomes are present instead of two.  A foetus may develop but it is abnormal and could never survive outside the womb, while part of the apparently normal placenta ‘overgrows’.

In both cases the level of the pregnancy hormone, hCG, present in the woman’s blood and urine is often abnormally high, resulting in increased likelihood of morning sickness and other pregnancy symptoms – a bitch considering that these are usually regarded as ‘good’ signs of a healthy pregnancy.  As with my first pregnancy, I had no sickness at all and looking back the only indicator was my ‘bump’, which was becoming pronounced even as early as 10 weeks, no doubt due to the abnormal enlargement of my womb which is also a symptom.

So what does all that mean and where does the ‘C’ word come in?  First of all it’s important to say that being diagnosed with a molar pregnancy does not mean you have cancer, or even that you are likely to get it.  The trouble with ‘moles’ is that they behave like tumours; they grow rapidly and if left unchecked they can spread to other parts of the body.  The first step your doctor will take upon diagnosis, if it hasn’t already been done, is to offer you a D&C to remove the foetus and/or placental tissue from your womb. In the majority of cases this is all that needs to be done – but you will be closely monitored for at least six months afterwards to make sure no cells have been left behind where they might grow again.

If you live in Northern Ireland, this follow-up is carried out through Charing Cross Hospital in London.  The hospital will send out information leaflets and a testing kit so that you can supply blood and urine samples for testing.  You do NOT have to draw your own blood, as I initially thought to my horror!  You can arrange for your blood to be drawn and sent to Charing Cross through your GP surgery.  In my case, my first set of blood and urine tests came back normal and so from now on I just send urine samples once a month for six months, which is much easier.  Provided that the level of pregnancy hormone in my urine stays normal, I will need no further treatment and we can try for another baby once the follow-up is complete – this is the case for the vast majority of women.

For some women, the level of hCG in the blood/urine remains high, rises or plateaus; a sign that abnormal cells from the placenta have been left behind and may be growing in the body.  These abnormal cells can get into the bloodstream through the vessel-rich uterine wall, and can spread to other parts of the body where they can cause a whole host of problems.  Treatment of cells that remain in the body is usually with chemotherapy, but it is important to note that even this does not mean you have cancer, and the chemotherapy is a mild form that does not usually affect future fertility.

A further complication of molar pregnancy is called choriocarcinoma.  This is a form of cancer and can occur as a result of a normal pregnancy, not just a molar, although it occurs most commonly following a complete mole.  It happens when part of the placenta becomes malignant, and cells can spread to other parts of the body including the lungs, liver and brain.  Choriocarcinoma responds well to chemotherapy and cure rates are excellent, even in cases where the cancer has spread.  Most women retain their reproductive function after treatment, although if you require chemotherapy treatment (regardless of whether you have had a persistent mole or a choriocarcinoma) you will be advised to wait for 12 months after treatment has finished before trying to conceive again.

This is by no means an exhaustive article on the subject of molar pregnancy and trophoblastic disease.  Two of the best resources on the web can be found on Charing Cross’s own website, and also at www.molarpregnancy.co.uk which was set up by a patient.

The emotional side of molar pregnancy is much more difficult to quantify and explain.  The grief at the loss of a baby is further compounded by fears for your own health.  If you have had a complete mole, you must come to terms with the fact that there never was a ‘baby’.  If you’ve had a partial mole, you might be upset by the notion that your much-wanted baby was in some way ‘abnormal’.  For me, the hardest thing about the molar has been the fact that we must now wait for follow-up to be complete before trying again.  After the miscarriage my sole focus was on conceiving again as quickly as possible – I felt this would set my life back on course somehow.  Being told that we couldn’t try again felt like being kicked while we were down.  Now that I’m two months into follow-up, though, I think the circumstances have given us some breathing space to deal with the loss of our baby.  It’s also made me appreciate how lucky we are to have Bubs and how much of a miracle it is that he’s here at all – pregnancy and birth are normal, everyday occurrences and yet they are so precarious, it’s taught me that when it comes to procreation, you can’t take anything for granted.