09 May Managing My Molar Pregnancy

When Elizabeth Kenyon is pregnant with her third child, things do not go according to plan.

My husband and I were very smug when we conceived our third child, as it happened exactly when we’d hoped. The ideal timing made up for the fact that in my first trimester, the exhaustion and nausea were much worse than they had been in my previous two pregnancies.

We didn’t bother with the six to eight-week scan, as we were certain of our dates, and I was obviously pregnant and growing. I was excited about the 12-week scan, however, and all the family accompanied me for the happy occasion. The sonographer was kindly tactful in front of the little ones when she explained that what she was seeing on the screen was not consistent with a 12-week pregnancy. An internal scan showed that the embryo had not progressed past the six-week stage. This was confounding. Why did I still feel so pregnant?

My GP explained that I’d had a ‘missed miscarriage’, which is when there are none of the usual miscarriage symptoms such as bleeding and cramping, and the body keeps building tissue. I was scheduled for a dilation and curettage (D and C) two days later.

A D and C is a surgical operation during which the doctor dilates your cervix and empties your uterus by gently scraping the uterine lining.

Part of the authorisation paperwork involved an agreement for the tissues removed to be tested in the pathology lab to ensure that it had not been a molar pregnancy. The doctor explained that this was purely routine and that molar pregnancies occur in only one in 1500 pregnancies.

It should have been a minor operation and a day procedure only, but my case was unusual as during the surgery, I haemorrhaged. After an overnight stay and blood transfusion, I was allowed home. I just needed to have my follow-up appointment at the hospital, and we could start trying to conceive again.

The results from pathology were delayed for a month, and then there were some “odd findings”. I was told to get a blood test to check my hCG (pregnancy hormone) levels while re-testing in pathology was done.

At this point, I started doing some research on molar pregnancies.

I soon learnt that a molar pregnancy is a form of gestational trophoblastic tumour. The condition happens when there is a problem during the fertilisation of the egg. You should receive 46 chromosomes in all, 23 from the mother and 23 from the father. If the egg does not receive either of the sets or if there is a duplication of a chromosome set, then it can lead to molar pregnancy. The first case is a complete molar pregnancy, and there is no embryo, no amniotic sac and no placental tissue. It will look like a cyst and can be determined only by way of an ultrasound. The second case is a partial molar pregnancy. The extra set of chromosomes leads to partial embryo development, but the embryo will not have any amniotic sac or placental tissue and thus cannot survive.

Once a molar pregnancy is identified, it has to be certain that the flawed genetic tissue is completely removed from the uterus, or there is a very small chance (about two per cent) that cancer of the uterus can develop.

I discovered that one of the few symptoms of a molar pregnancy is unusually high levels of hCG hormones. Also, the molar tissue can be hard to remove without additional bleeding. This would explain the severe pregnancy symptoms and haemorrhaging I had experienced, So I was not entirely surprised when, six weeks after the D and C, the hospital called to confirm I’d had a partial molar pregnancy and an appointment was made for me to see an oncologist.

Most of the information I had read suggested I would have to wait a whole year until trying to conceive again. Thankfully, after just six months of regular blood tests and three visits to the oncologist, I was given the all-clear.

Statistics show that I am not at increased risk of having another molar pregnancy just because I have had one previously, but I will certainly be getting that early ultrasound next time!