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Molar pregnancies

Last reviewed: 9 Nov 2024
Last updated: 18 Jan 2024

Summary

Definition

History and exam

Key diagnostic factors

  • first trimester of pregnancy
  • vaginal bleeding
  • unusual uterine size for gestational age
Full details

Other diagnostic factors

  • early-onset preeclampsia
  • shortness of breath and respiratory distress
  • severe nausea and emesis
  • tachycardia, tremor, insomnia, and diarrhea
  • pallor
  • pelvic pain
  • uterine bleeding
Full details

Risk factors

  • extremes of maternal age
  • prior molar pregnancy
  • diminished dietary fat and carotene
Full details

Diagnostic tests

1st tests to order

  • histologic exam of placental tissue
  • serum human chorionic gonadotropin (hCG)
  • pelvic ultrasound
Full details

Tests to consider

  • CBC
  • serum PT, PTT
  • serum metabolic panel
  • serum thyroid-stimulating hormone (TSH)
  • blood type with antibody screen
  • CXR
Full details

Treatment algorithm

ACUTE

singleton molar pregnancy: desiring fertility

singleton molar pregnancy: not desiring fertility

viable twin fetus: elective termination not desired

viable twin fetus: elective termination

ONGOING

following initial management: high risk of gestational trophoblastic neoplasia with completed follow up unlikely

Contributors

Authors

Antonio Braga, MD

Associate Professor

Department of Obstetrics and Gynecology

Rio de Janeiro Federal University

Department of Maternal Child

Fluminense Federal University

Rio de Janeiro

Brazil

Disclosures

AB is an author of references cited in this topic.

Kevin M. Elias, MD

Assistant Professor

Brigham and Women’s Hospital

Dana Farber Cancer Institute

New England Trophoblastic Disease Center

Division of Gynecologic Oncology

Department of Obstetrics, Gynecology and Reproductive Biology

Harvard Medical School

Boston

MA

Disclosures

KME has been a paid consultant for AOA Dx and received research support from Aspira Women’s Health and Abcam, Inc. KME is an author of references cited in this topic.

Neil S. Horowitz, MD

Associate Professor

Brigham and Women’s Hospital

Dana Farber Cancer Institute

New England Trophoblastic Disease Center

Division of Gynecologic Oncology

Department of Obstetrics, Gynecology and Reproductive Biology

Harvard Medical School

Boston

MA

Disclosures

NSH is an author of references cited in this topic.

Ross S. Berkowitz, MD

William H. Baker Professor of Gynecology

Brigham and Women’s Hospital

Dana Farber Cancer Institute

New England Trophoblastic Disease Center

Division of Gynecologic Oncology

Department of Obstetrics, Gynecology and Reproductive Biology

Harvard Medical School

Boston

MA

Disclosures

RSB is an author of references cited in this topic.

Acknowledgements

Dr Ross S. Berkowitz, Dr Kevin M. Elias, Dr Neil S. Horowitz, and Dr Antonio Braga would like to gratefully acknowledge Dr John Soper and Dr Emma Rossi, previous contributors to this topic. JS and ER declare that they have no competing interests.

Peer reviewers

Jane Stewart, PhD, MSc

Consultant Gynecologist

Subspecialist in Reproductive Medicine

Newcastle Fertility Centre at Life

Bioscience Centre

International Centre at Life

Newcastle upon Tyne

UK

Disclosures

JS declares that she has no competing interests.

Philip Savage, PhD, FRCP

Consultant in Medical Oncology

Department of Medical Oncology

Charing Cross Hospital

London

UK

Disclosures

PS declares that he has no competing interests.

Aparna Sundaram, DO, MBA, MPH

Physician Consultant

Preventive Medicine

Private Practice

Atlanta

GA

Disclosures

AS declares that she has no competing interests.

  • Molar pregnancies images
  • Differentials

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    • Spontaneous abortion
    • Multiple gestation
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  • Guidelines

    • Epidemiology, diagnosis, and treatment of gestational trophoblastic disease
    • Diagnosis and treatment of gestational trophoblastic disease
    More Guidelines
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