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'I'd lost my dream of a baby and what I saw looked alien'.

Byline: By Madeleine Brindley Western Mail

Discovering that you are pregnant can be one of the happiest moments in a woman's entire life. But, for a small number of women, there will be no baby, just a small clump of cells, which could have a serious impact on their health. Claire Bruford reports on molar pregnancies

A MOLAR pregnancy, which is known medically as a hydatidiform mole, is an abnormality of the placenta caused when the sperm fertilises an egg without a nucleus.

A baby is not always present and the cells that line the gestational sac begin to convert into a growth resembling a cluster of watery grapes, thus signifying an abnormal placenta - hydatid literally means a watery cyst.

There are two types of molar pregnancy, complete and partial. A complete molar pregnancy occurs when a sperm fertilises an empty egg with no nucleus and only the placenta is formed.

As the placenta grows the pregnancy hormone HCG is produced, making the mother believe that she is pregnant with a healthy baby.

But an ultrasound will show only a placenta. No baby will grow.

Normally a developing baby's chromosomes are made up of half from the mother and half from the father.

In the case of a complete molar pregnancy the fertilised egg's chromosomes come from the father. Shortly after fertilisation has taken place the chromosomes from the mother's egg are inactivated and the father's chromosomes are duplicated.

A partial molar pregnancy occurs when an egg is fertilised by two sperm. Instead of forming twins, an abnormal foetus and abnormal placenta will develop.

As the baby has too many chromosomes it normally always dies within the womb and is consumed very quickly by the developing mass.

In the case of a partial molar pregnancy the mother's 23 chromosomes still exist but there are two sets from the father resulting in the embryo having 69 chromosomes instead of 46.

About one in every 1,000 women has a molar pregnancy, but the risks of developing a molar pregnancy are higher if the mother is under 20 years of age or over 40 and if the mother has had two or more miscarriages.

If a molar pregnancy has been experienced in the past there is a 1% to 2% chance of another one occurring.

A molar pregnancy will present the same symptoms as a normal pregnancy during the first trimester - the woman will experience fatigue, tender breasts, nausea and vomiting and a missed period.

Many molar pregnancies appear completely normal and nothing would make the mother suspicious of anything being wrong.

But bleeding can start as early as six weeks and as late as 16 weeks. Other ways of recognising molar pregnancies include, vaginal bleeding during the first trimester; discharge of tissue that looks like the shape of a cluster of grapes; enlarged ovaries that are detected by an ultrasound; a uterus that grows too quickly, and high levels of HCG which is detected though a blood test.

Severe nausea, vomiting and high blood pressure, signs of hyperthyroidism such as weight loss, increased heart rate, sweating; and heat intolerance, muscle weak- ness and thyroid enlargement could also indicate a molar pregnancy.

Although most molar pregnancies are expelled from the body, there are long-term health consequences is not all the tissue is removed.

In about 20% of complete moles and 2% of partial moles, there is some molar tissue left inside of the uterus, which can continue growing and lead to abnormal vaginal bleeding and risk of infection.

Referred to as gestational trophoblastic neoplasia, this complication can be treated with the drug, methotrexate, which is highly effective at ending the growth of the mole.

Rarely a gestational trophoblastic neoplasia can become cancerous and invade other organs. In particular, the mole's cells can begin to grow in the lungs, brain, bones or vagina. If left untreated this can be a deadly complication. However, using a chemotherapy drug, or a combination of chemotherapy drugs, is almost 100% effective at stopping the spread of the cancer.

Paula Sinclair, from Swansea, started bleeding when she was nine weeks pregnant.

When she was taken to hospital for a scan she was told that she had a partial molar pregnancy.

She said, 'I was totally shocked. I'd never even heard of such a thing and the thought of getting cancer from being pregnant was completely frightening.

'I had an emergency D&C the same afternoon as my scan. The following day I was given another scan and an X-ray and was told that all of the pregnancy tissue had been removed, that I would be fine and wouldn't need any other treatment.

'I was so relieved. I still had to have check-ups with my GP and was told not to get pregnant within a year. Although I'd lost my baby, which took a long time to recover from, I was glad I had my health.'

Molar pregnancies can be diagnosed in several ways - by a pelvic examination, which will reveal a larger or smaller than usual uterus and enlarged ovaries which are caused by the non-cancerous cysts from abnormally high levels of HCG.

Blood is tested for increased or decreased levels of HCG. If the pregnancy is a complete mole then the HCG levels would be much higher than a normal pregnancy and if it is a partial mole then the HCG levels would be much lower than normal.

An ultrasound can also detect a molar pregnancy and the cluster of grape like cysts would be clearly visible.

If a molar pregnancy is not suspected then it may proliferate until the woman has her routine ultrasound. With the appropriate treatment nearly all molar pregnancies are curable.

A molar pregnancy can be very frightening as well as worrying, as not only does the woman have the pain of losing a baby but her health can be in jeopardy.

A D&C - dilation and curettage, which involves the scraping of the lining of the uterus - is usually carried out and all tissue is removed from the uterus. If the woman does not want anymore children then in some instances a hysterectomy maybe carried out to ensure that the woman does not develop gestational trophoblastic disease.

It is usual for the woman to have a chest X-ray to ensure that no abnormal cells from the mole have spread to the lungs which is the most common site of spreading.

After the D&C and X-ray it is paramount that the woman continues to see her GP for follow up treatment as cancerous cells can reoccur. Anyone who is RH negative will be given a rhogam shot.

It is normal to have physical examinations of the vagina and uterus every two weeks until it returns to normal size and then every three months for a year. Patients are also advised not to get pregnant for one year as HCG levels need to be monitored weekly until they fall to zero and then every month for one year, to ensure that the cancerous cells have not come back.

Brenda Mithey, from Cardiff, had a complete molar pregnancy and had to have a D&C to remove the growth, followed by chemotherapy to kill off any remaining cancerous cells.

She said, 'I thought I was pregnant with a baby and at my 12 week scan I was shown a group of cells that looked just like a bunch of grapes.

'I was told that there was no baby and never had been.

'That's the day the nightmare began.

'I had to have a D&C and as some of the tissue was left behind I ended up having chemotherapy to treat any cells that had spread. I was told not to get pregnant for at least a year and had to have monthly check-ups with my doctor for a year.

'I'd lost my dream of a baby and what I saw just looked alien.

'After two-and-a-half years I am now pregnant again and have had scans which have shown a perfect looking baby. It has been a very frightening journey.'

A molar pregnancy does not affect future fertility and will not increase any risks of having a still birth, birth defects or complications with delivery. But it can take a long time to recover from a molar pregnancy as not only does the woman lose the baby that she thought she was carrying along with all the dreams of having a baby, she also needs to contend with health issues.: Support groups offer information and support:Support groups for people affected by molar pregnancies include:MyMolarPregnancy.com (www.mymolarpregnancy.com), which provides information, links, references and support groups for anyone who has suffered a molar pregnancy; Hydatidiform Mole and Choriocarcinoma UK Information and Support Service (www.hmole-chorio.org.uk or 020 8846 1409), and offers information and support for anyone who has suffered a molar pregnancy;

Miscarriage Association (www.miscarriageassociation.org.uk or 01924 200799), which provides information and support for anyone who has suffered a miscarriage of any kind, including molar pregnancy; Babyloss (www.babyloss.com), which offers information and support online for anyone affected by the death of a baby at any stage of pregnancy.
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Title Annotation:Features
Publication:Western Mail (Cardiff, Wales)
Date:Mar 5, 2007
Words:1533
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