WHAT IS MOLAR PREGNANCY?
Not every situation where a pregnancy test is positive is a sign of a live, healthy baby. Molar pregnancy is an unhealthy type of pregnancy. Molar pregnancy is defined in the writings of Hippocrates as "a mother carrying a thousand babies". It is popularly known as "grape pregnancy". Due to the presence of a genetically defective embryo with an abnormal chromosome sequence, the uterus is filled with grape-shaped, abundant, fluid-filled structures called swollen vesicles. Its incidence has been reported as 1 in 1000-2000 pregnancies. For those who have had a molar pregnancy before, the risk of having a molar pregnancy again increases by 10 times and rises to 1%.
HOW DOES A MOLAR PREGNANCY OCCUR?
Healthy. During pregnancy, during fertilization, the egg cell takes in a single sperm and closes the entrance gates. Thus, the embryo, which receives 23 chromosomes from the mother's egg cell and 23 chromosomes from the father's sperm, consists of 46 chromosomes. However, in a molar pregnancy, two sperm enter the egg cell and embryos with strange chromosome numbers are formed.
WHAT ARE THE TYPES OF MOLAR PREGNANCY?
There are two types: Complete ( full) and partial mole. The complete form is more common and is more dangerous and can turn into cancer. If two sperms manage to enter the egg cell and the genetic information of these sperms, consisting of 23 chromosomes each, combines in the nucleus of the egg cell and causes the egg's own genetic information to be destroyed, the embryo consists of 46 chromosomes. Even though the chromosome number is normal, this strange embryo, which has not received any genetic structure from the mother, produces an abnormal pregnancy product that does not contain any fetal structures and consists of abundant swollen villi. This is called complete molar pregnancy. If two sperms manage to enter the egg cell and their genetic information, which consists of 23 chromosomes each, do not combine in the nucleus of the egg cell and cause the egg's own genetic information to be destroyed, the embryo consists of 69 chromosomes. Although structures belonging to the fetus appear, this abnormal fetus is not compatible with life. Together, an abnormal pregnancy product with many swollen villi occurs. This is called partial molar pregnancy. Complete mole, earlier pregnancy It gives symptoms when they are important. Since the fetus forms in partial mole, diagnosis may sometimes be delayed until the 20th week. Fetus observed in partial mole often results in intrauterine death due to triploidy (chromosomal number being 69).
WHAT ARE THE CAUSES OF MOLAR PREGNANCY?
•Low socioeconomic level
p>•Poor nutrition
•Folic acid and carotene deficiency
•Maternal age over 40 years of age
•Maternal age under 20 years of age
•Being of Far Eastern origin
•Having had two or more molar pregnancies before
•Having had more than one miscarriage in the past
WHAT ARE THE SYMPTOMS OF MOLAR PREGNANCY?
The first symptom is the onset of bleeding following menstrual delay. The amount of pregnancy test (B-HCG) in the blood is much higher than normal. Nausea and vomiting are more severe than normal. Although very rare, conditions such as large ovarian cysts (theca lutein), high blood pressure (preeclampsia), overactivity of the thyroid gland (hyperthyroidism), and excessive hair growth (due to high testosterone) may occur. Some pregnant women may apply with the complaint of "dropping a piece similar to a grape." Symptoms may be milder in partial mole compared to complete mole and may show symptoms at a later period.
HOW IS MOLE PREGNANCY DIAGNOSIS?
Diagnosis is made by ultrasonography. A gestational sac is not seen inside the uterus. Instead, swollen molar vesicles line up side by side, creating a “snowfall landscape.” During the examination, the uterus may be measured larger than the gestational age. A pregnancy test measured in blood with a B-HCG value above 100,000 supports the diagnosis. Unfortunately, diagnosing a partial mole may not be as easy as a complete mole. A gestational sac is usually present on ultrasound. If there is a fetus in the sac, it may be mistakenly thought to be a normal pregnancy. Therefore, the placenta must be examined carefully to diagnose a partial mole. Complete molar pregnancy, if left untreated, usually ends in miscarriage by the 16th week of pregnancy. In the partial type, it may continue for a longer time.
HOW IS MOLAR PREGNANCY TREATED?
After the diagnosis of molar pregnancy is made, the pregnancy should be terminated without any delay by talking to the family. For this purpose, general anesthesia is used Abortion is also applied. Before discharge, a chest x-ray is taken to investigate possible cancer and metastasis and the B-HCG value is monitored. Blood type is determined and if there is Rh incompatibility, Anti-Rh immunoglobulin (incompatibility shot) is administered. If bleeding is severe, blood transfusion may be given. The probability of undesirable situations due to abortion during mole evacuation increases depending on the week of gestational age. Uterine injury, perforation; The occurrence of undesirable conditions, especially infection and bleeding, is directly related to the size of the gestational age. Therefore, early diagnosis of molar pregnancy is important. In mole evacuation, unlike normal pregnancy evacuation, there is a risk of pulmonary embolism (clogging of the artery itself or one of its branches by a substance coming through the circulation) by passing one of the trophoblasts to the blood vessels during the intervention. Also, rarely, a dangerous condition called DIC (disseminated intravascular coagulation) may develop after evacuation. The parts found during evacuation must be sent for pathological examination. For a woman with a molar pregnancy, if she has completed the number of children and is over the age of 40, hysterectomy (surgical removal of the uterus) is an appropriate treatment method. Hysterectomy significantly reduces the risk of developing cancer after a molar pregnancy, but does not completely eliminate it. Therefore, even if a hysterectomy is performed, the follow-up continues in the same way.
HOW IS MOLAR PREGNANCY FOLLOWED?
Molar pregnancy may recur, so patients are closely monitored. During the follow-up period, the patient is prohibited from becoming pregnant for 1 year. Birth control pills are started, intrauterine device (IUD) is not suitable. If pregnancy occurs during this period, it is not possible to distinguish whether the rising B-HCG is due to a natural pregnancy or a possible recurrence. During follow-up, weekly measurements are made until blood B-HCG levels reach zero. When B-HCG is measured as zero three times, the follow-up is changed from weekly to monthly. Patients are monitored monthly for 1 year. At the end of 1 year, if everything is normal, the patient is allowed to become pregnant. The risk of having a second molar pregnancy after a molar pregnancy is 1%. Therefore, when getting pregnant again, caution should be taken.
IS MOLAR PREGNANCY DANGEROUS?
Molar pregnancy, Gestational Trophoblast It can turn into a type of tumor formation called neoplasia (GTN). GTN is a disease that can spread (metastasize) to other parts of the body or recur in the uterus. If the patient's blood B-HCG levels do not decrease during follow-up, remain the same, or begin to increase again after decreasing for a while, GTN is likely to develop. GTN occurs following molar pregnancy in 50% of cases, miscarriage in 25% of cases, and normal pregnancy in 25% of cases. It responds very well to chemotherapy. Otherwise, other treatments such as hysterectomy and intra-arterial chemotherapy may be required. The most commonly used chemotherapeutic agent is Methotrexate. Apart from this, agents such as Actinomycin-D, Etoposide and 5-Fluorouracil can be used.
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