Molar pregnancies

Last reviewed: 21 Apr 2022
Last updated: 25 Feb 2021

Summary

Definition

History and exam

Key diagnostic factors

  • first trimester of pregnancy
  • missed period
  • vaginal bleeding
  • unusually large uterus for gestational age
More key diagnostic factors

Other diagnostic factors

  • headache and photophobia
  • shortness of breath and respiratory distress
  • severe nausea and emesis
  • tachycardia, tremor, insomnia, and diarrhea
  • hypertension
  • pallor
  • pelvic pain
  • uterine bleeding
  • peripheral edema
Other diagnostic factors

Risk factors

  • extremes of maternal age
  • prior gestational trophoblastic disease (GTD)
  • blood group A, B, AB
  • tobacco use
  • diminished dietary fat and carotene
More risk factors

Diagnostic investigations

1st investigations to order

  • serum beta human chorionic gonadotropin (hCG)
  • CBC
  • serum PT, PTT
  • serum metabolic panel
  • serum thyroid-stimulating hormone (TSH)
  • blood type with antibody screen
  • pelvic ultrasound
  • CXR
  • histologic exam of placental tissue
More 1st investigations to order

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

John Soper, MD

Professor

Department of Obstetrics and Gynecology

University of North Carolina

Chapel Hill

NC

Disclosures

JS is an author of references cited in this topic.

Emma Rossi, MD

Assistant Professor

Department of Obstetrics and Gynecology

University of North Carolina

Chapel Hill

NC

Disclosures

ER declares that she has 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.

Use of this content is subject to our disclaimer