Introduction

Molar pregnancies are a rare benign (non-cancerous) condition also referred to as gestational trophoblastic disease. This is when genetic complications occur after an egg has been fertilised leading to excessive proliferation of cells which make up the placenta.⁵ The outcome of this is that the placenta does not form properly, therefore the baby cannot develop properly which leads to loss of pregnancy. This article will explore the two types of molar pregnancy: complete and partial and will explore the emotional and psychological impacts that come with miscarriage. 

Understanding molar pregnancy

A molar pregnancy can also be referred to as a Hydatidiform mole. This comes under two types:

Complete mole

A complete mole is the more common type of molar pregnancy and occurs in around 90% of cases. When this occurs there is no presence of a baby post-conception but a scan of the womb would display a grape-like structure due to the excessive proliferation of trophoblastic cells that are crucial to the formation of the placenta.⁶

Partial mole

A partial mole is less common however can still occur. This type of molar pregnancy occurs when both a baby and the placenta can be seen present in a scan of the womb. These are abnormal and the baby will be unable to fully develop and therefore will not survive.⁶

Risk factors

Molar pregnancies are rare and do not have a direct cause, they occur by chance. It is not a direct result of abnormalities of the sperm or abnormalities of the egg. It is genetic errors that occur during fertilisation which is not something that can be prevented. There are risk factors that increase the chance of molar pregnancy. These include:²

• Reproductive age: those at early stages of puberty and those over the age of 45 who have not yet hit menopause
• Individuals with an Asian ethnic background
• Individuals who have already experienced a molar pregnancy before

Symptoms and diagnosis

In the early stages of a molar pregnancy symptoms may not occur at all or they can be the same as that of a regular pregnancy such as nausea, vomiting and pelvic pain. Molar pregnancies are typically diagnosed during ultrasound scanning. Evidence of a molar pregnancy can be found on the first pregnancy scan usually around 8 to 14 weeks into the pregnancy.⁴ In some cases the pregnancy will not last that long and an individual may find out when a miscarriage occurs. The main sign of miscarriage is vaginal bleeding.

Testing for molar pregnancy

Testing for molar pregnancy can be done in multiple ways. The first previously mentioned is an ultrasound scan of the womb. This can help to identify whether a complete or partial molar pregnancy has occurred due to the grape-like structure which resembles a complete molar pregnancy. Another option would be to perform a blood test to investigate the levels of hCG which is the pregnancy hormone detected in pregnancy test sticks. This hormone tends to be elevated beyond the norm in the occurrence of a molar pregnancy. A final way if a miscarriage has already occurred would be at an appointment with a gynaecologist who specialises in reproductive health.⁴ 

Treatment and recovery

A molar pregnancy can be devastating for patients. If a molar pregnancy has happened then there will either be no presence of the baby or the baby will not be able to survive as it cannot develop properly.. Ultimately, the pregnancy will be lost and lead to miscarriage. Miscarriage can occur naturally and if not the pregnancy can be eliminated at the hospital through oral medication or under a procedure using general anaesthetic. 

Physical recovery

Once the pregnancy has been removed physical recovery is important. Hence follow-up care with your doctor including urine samples to observe hCG hormone levels. If hCG hormone levels do not decrease back to normal then further treatment may be required and investigated. Other physical side effects will also be monitored such as blood pressure which increases during molar pregnancy as well as any vaginal bleeding or suspicious discharge.¹

Mental recovery

Miscarriage can be an emotionally and psychologically damaging experience. The loss of an unborn child particularly by molar pregnancy in which there is no treatment or way to save the pregnancy can be a lot to deal with for both the mother and father of the child. Immediate emotional reactions tend to consist of shock and disbelief. During this time there is also grief and loss. It is important to know that there are support groups and networks available for individuals who have had or are currently going through a miscarriage and it can help to seek out others for support.^4,1

Psychological impact

Psychologically a molar pregnancy can impact individuals in a variety of ways. One of these includes coping with procedures to terminate the pregnancy. Some may believe this is ethically wrong however in order to produce the best health outcome for the patient the baby in its early developing stages must be removed as it will not survive and not removing it can lead to hCG levels continually increasing. The patient would then need chemotherapy as a means of treatment.² 

Another psychological impact of molar pregnancy is detachment or fear of intimacy. Miscarriage can lead to a lower sex drive due to the fear of conception which results in a miscarriage. Awareness that a previous molar pregnancy is classed as a risk factor of one occurring again can prevent individuals from wanting to conceive. According to Cancer Research UK, 99% of individuals who have had a molar pregnancy will not have another one(1). It is important to discuss with your doctor if you are firstly physically ready to be pregnant again but it is equally important that you are emotionally ready too. However, just because the risk of a molar pregnancy happening again doesn't necessarily mean that it will. If fear of recurrence is beginning to impact relationships and mental health this may lead to more long-term grief and depression.³

Coping mechanisms and support systems

Coping mechanisms can be different for everyone. These may include:

Counselling and therapy can help individuals discuss and open up about how their experience is affecting them to professionals who can listen and aid advice for the emotional and psychological effects a miscarriage due to molar pregnancy has caused.

Support groups which with today's technology can be done in-person or online. These can help individuals support one another who have been through similar traumatic and damaging experiences with miscarriage and molar pregnancy. It is a way to feel connected and understand you are not alone and that other people have gone through or are going through a similar recovery journey as you.

If you do not know where to go to find support you can speak to your doctor or use websites such as Cancer Research UK, NHS Online and other online healthcare providers can be a good start as they have many support links available. It is important to seek medical attention whether physical, mental or psychological.

Summary

Molar pregnancy is a deeply impactful experience. Although rare, the emotional and psychological impacts can affect an individual's quality of life with short-term emotional and long-term mental side effects. Not only this but it can cause problems for people's relationships and closeness with others. The loss of an unborn child is something nobody wants to deal with and patient care is important for not only physical but emotional and psychological aspects too. So if you or anyone you know is dealing with the effects of molar pregnancy it is important to seek help and take time to recover and process this loss.