Molar Pregnancy: Treatment Overview

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Treatment Overview

A molar pregnancy is removed with vacuum aspiration under general anesthesia. Pelvic ultrasound may be used during the procedure to guide removal of all the abnormal tissue. Medication (oxytocin) is used during or after the procedure to make the uterus contract—uterine contractions help the uterus shrink to its prepregnancy size and help stop uterine bleeding after the mole is removed.

If you have Rh-negative blood, you will also have a shot of Rh immune globulin. This prevents a problem called Rh sensitization, which can cause serious problems in a future pregnancy.

If you have no future plans to become pregnant, you may consider a hysterectomy, which reduces the chance of developing gestational trophoblastic disease after a molar pregnancy.

If you are considered high risk for developing cancer after a molar pregnancy, you may be treated with methotrexate to prevent persistent cell growth.

In the very rare case that a normal fetus is present along with a mole, the fetus is monitored closely and delivered as soon as possible.

Important follow-up care

If you have had a molar pregnancy, it is important to see your health professional for regular follow-up visits to watch for any cancerous cell growth. Follow-up measures include:

• Measuring hCG levels every 1 to 2 weeks until they are normal, then measuring them every 1 to 2 months for 6 months to a year. Levels of hCG that stay high may be a sign of cancer.
• Preventing pregnancy while hCG levels are being monitored, usually about 6 months. It is very important that you practice highly effective birth control during the entire period of follow-up. For more information on contraception, see the topic Birth Control.
• Close medical supervision if you happen to conceive within 12 months of molar pregnancy treatment.

An obstetrician, a gynecologist, or a doctor specializing in reproductive cancer (gynecologic oncologist) can treat a molar pregnancy.

If you are diagnosed with trophoblastic cancer

Most cases of trophoblastic cancer are confined to the uterus. If you are diagnosed with this low-risk and highly curable type of cancer, you will probably receive one or more series of a medicine—either methotrexate or actinomycin D.

If you are diagnosed with cancer that has spread to other parts of the body, you will probably be treated with a combination of chemotherapy medicines.

Fertility and coping after a molar pregnancy

After a molar pregnancy, your chances of having a successful pregnancy are about the same as those of the general population of childbearing women, even if you have been treated for trophoblastic disease.⁶ But you do have an increased risk for having another molar pregnancy. So, your health professional will want to monitor you closely during and after any future pregnancies. Pregnancy care will include:

• Routine prenatal care and a late first-trimester fetal ultrasound to confirm a healthy pregnancy.
• Checking hCG levels 6 weeks after childbirth to confirm that no trophoblastic disease has developed.

Having a molar pregnancy can challenge your emotional and physical well-being. Grief about losing a pregnancy, combined with fear of cancer, may feel like more than you can handle. Consider contacting a support group or talking to friends, a counselor, or a member of the clergy to help you and your family deal with this difficult time. For more information, see the topic Grief and Grieving.

Last updated:	October 29, 2007
Author:	Kathe Gallagher, MSW
Reviewed By:	Joy Melnikow, MD, MPH - Family Medicine, Kirtly Jones, MD - Obstetrics and Gynecology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC