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The term gestational trophoblastic disease (GTD) covers several pregnancy conditions that involve the placental tissue turning cancer-like, or cancers originating from placental tissue. In Australia, this condition occurs in one in every 600 to 1000 pregnancies. The main types of GTD are hydatidiform mole (also known as molar pregnancy; this is the most common form) and gestational trophoblastic neoplasia (also known as persistent gestational trophoblastic disease or persistent GTD). Molar pregnancy is a form of abnormal pregnancy, in which the formed placental-like tissue sometimes invades the wall of the uterus. In most cases, the woman miscarries and passes the mole from her body, or it is removed with a surgical procedure called a dilatation and curettage (D&C). This procedure is also known as an evacuation of the uterus. If treated early, molar pregnancy is 100 per cent curable. The cause of molar pregnancy is unknown, but a key risk factor is maternal age. Women aged less than 20 years or more than 40 years are most at risk. Symptoms of molar pregnancyThe symptoms of molar pregnancy can include:
More rarely, when a diagnosis is not made until later gestation, symptoms include:
Risk factors for molar pregnancyThe cause of molar pregnancy is unknown, but risk factors include:
Formation of a molar pregnancyAfter fertilisation, developing cells split into two broad groups – one group becomes the fetus and the other becomes the placenta. The placenta has millions of tiny finger-like projections (villi) that are designed to ‘dig in’ to the womb wall and tap into the mother’s blood supply. There are two forms of molar pregnancy – complete mole and partial mole. In complete molar pregnancies, there is no foetus, and the placenta grows abnormally. The villi swell and look like little blisters. These blisters are called a hydatidiform mole. In partial molar pregnancies there is some development of the fetus but it is not normal and cannot survive. When a woman has a molar pregnancy she experiences the symptoms of pregnancy because the placenta continues to make the pregnancy hormone human chorionic gonadotrophin (hCG). However, the level of hCG is usually higher than normal, which explains why morning sickness can be sometimes more severe than usual. In some cases, the morning sickness is so severe that hospitalisation is needed. Complications of molar pregnancyMolar pregnancy is usually diagnosed early with minimal symptoms, but if diagnosis is delayed the following complications can arise:
If a molar pregnancy is not treated or does not miscarry completely it can progress and cause a range of serious conditions (known as gestational trophoblastic neoplasia), including:
Diagnosis of molar pregnancyMolar pregnancy is diagnosed using:
Molar pregnancy can be hard to diagnose because:
Treatment of molar pregnancyPromptly treated, molar pregnancies are curable in 100 per cent of cases. Treatment options depend on various factors, including whether or not the tumour has spread to other areas of the body, but could include:
Further treatment is required in 10 per cent of all cases. Molar pregnancy can persist (continue) after an evacuation procedure. There is a 15 to 25 percent chance of a complete mole persisting, and a 0.5 to 4 per cent chance of a partial mole persisting, so regular monitoring of your hCG levels is required. The primary test is a blood test for hCG, but sometimes the 24-hour collection of urine can be used to measure hCG levels. If the hCG level does not fall or continues to rise, or if further tests such as x-rays and scans show that spread has occurred and you are diagnosed with persistent GTD, you will need chemotherapy. It is important to strictly avoid pregnancy until your hCG level has returned to normal, because a normal pregnancy will produce hCG and make the monitoring blood tests ineffective. If you need chemotherapy, avoid becoming pregnant for the first year after completion of the treatment so that your hCG blood tests are effective, and to avoid harm to your developing baby. In Victoria, all women with a hydatidiform mole pregnancy are registered on the Royal Women’s Hospital’s Gestational Trophoblastic Disease . Follow-up is monitored and support is available for women with this diagnosis. Queensland also has a state but in other states in Australia, care is usually provided by a specialist gynaecologist. Where to get helpThis page has been produced in consultation with and approved by:
This page has been produced in consultation with and approved by:
This page has been produced in consultation with and approved by:
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