Fact sheet
Molar Pregnancy
When a woman receives the diagnosis of molar
pregnancy, it sounds like one more thing to worry
about when you are often already upset about
losing the pregnancy. We hope this fact sheet will
reassure you that almost all molar pregnancies
have an excellent outcome and your future chance
of a normal pregnancy is very high.
This fact sheet will also help you understand what
having a molar pregnancy means, and what
treatment and follow up are needed.
Molar pregnancy is part of a larger group of
conditions with the medical name gestational
trophoblastic disease (GTD). Molar pregnancy is by
far the most common type of GTD and is the only
one covered in this fact sheet.
Molar pregnancy has two groups - complete mole
and partial mole.
 As the pregnancy grows, it often looks like a
bunch of tiny cysts. This is why you often see
the word ‘hydatidiform’ (cyst) included in the
name, e.g. complete hydatidiform mole.
 Sometimes the tiny cysts grow (burrow) into the
wall of the uterus (womb) - this explains the
name ‘mole’ which is a burrowing animal.
What is a molar pregnancy?
A molar pregnancy is an uncommon type of
miscarriage. There is either no embryo (earliest
stage of a baby’s development) or an abnormal
embryo, plus a large amount of abnormal placental
tissue (the placenta is the afterbirth – its role is to
bring oxygen and food to the baby during
pregnancy). Molar pregnancies are caused by a
chance mistake of nature that occurs at the moment
the pregnancy begins.
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Molar pregnancy occurs in 1 per 1000 pregnancies.
It makes up about 2% of miscarriages (unsuccessful
pregnancies). Each year in Australia, around 300
women have a molar pregnancy. If a woman has
had a molar pregnancy before, there is around 1%
chance she will have another one and around 99%
chance that she won’t.
More than 300 Australian Women have a
Molar Pregnancy every year
Why does a molar pregnancy occur?
Molar pregnancy occurs by chance, a mistake of
nature. While it is a bit more common in women
under 20 years and over 40 years, and in women
from some world regions such as Asia, the fact is it
can happen to any woman. There is nothing a
woman/couple can do to cause it or prevent it.
At the beginning of a normal pregnancy, the sperm
and egg join together to form a normal embryo and
a normal placenta. A sperm has 23 chromosomes
and an egg has 23 chromosomes (long strands of
genes / DNA inside our cells). After they join
together, the pregnancy has 46 chromosomes half
from each parent.
In a molar pregnancy, the joining together of the
sperm and egg doesn’t happen in the usual way.
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There are two types of molar pregnancy:
 Complete Mole:
A complete mole happens when a sperm joins with
an egg that has lost its own chromosomes/genes.
Once the sperm is inside the empty egg, it
duplicates (makes a copy of) its own genes. There
are then 46 chromosomes, but they all come from
the father (sperm), with none from the mother (egg).
Without genes from the mother, an embryo cannot
develop. However there is a large and abnormal
placenta due to the increased number of genes
from the father (sperm genes are important for
making the placenta).
 Partial Mole:
Here, two sperm join with one egg and form a
pregnancy with 69 chromosomes. In a partial mole,
an embryo may develop, but it is always abnormal
and cannot survive. Because of the extra sperm
genes, the placenta is large and abnormal.
Partial molar pregnancies are 2 - 3 times more
common than complete molar pregnancies and tend
to cause fewer problems.
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bhCG (pregnancy test hormone)
The pregnancy test hormone (bhCG) is made by the
placenta. In molar pregnancies, the larger placenta
often makes more bhCG than usual. When treating
molar pregnancies, we follow the bhCG level to
make sure the molar pregnancy is going away.
Why is a molar pregnancy important?
Most molar pregnancies are cured by a quick day-
surgery operation known as suction curettage or
D&C - see below. This simple operation cures over
98% of partial moles and over 80% of complete
moles.
The reason molar pregnancies are important, is
because some cases can turn into cancer and need
treatment with cancer medication (chemotherapy). If
you have a molar pregnancy, we will keep close
watch over you to make sure everything is going
well and that you get the treatment you need.
The two main types of cancer developing after
molar pregnancy are called:
 Persistent molar pregnancy (persistent GTD,
sometimes called invasive mole)
 Choriocarcinoma
Persistent molar pregnancy
This is when some molar tissue won’t come away
and stays behind in the uterus after the small
operation to empty the uterus. This tissue may also
grow into the wall of the uterus. The good news is
that persistent molar pregnancy can nearly always
be cured with chemotherapy.
Persistent molar pregnancy occurs in:
 about 15 - 20% of complete moles
 about 1- 2% of partial moles.
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Choriocarcinoma
Very rarely, a molar pregnancy can form a more
aggressive type of cancer called a choriocarcinoma
which can spread around the body.
Choriocarcinoma occurs in:
 About 2-3% of complete moles
 Under 1% of partial moles
Like persistent molar pregnancy, choriocarcinoma
can be cured almost 100% of the time with
chemotherapy.
This is because the ultrasound diagnosis of molar
pregnancy before 12 weeks is not always accurate.
 Sometimes the ultrasound looks like a molar
pregnancy, showing a bunch of cysts in side the
uterus (image).
 Yet, at other times it looks like an ordinary
miscarriage.
 Working in the opposite direction, sometimes
when ultrasound suggests the pregnancy may
be molar, it turns out to be a normal miscarriage.

How is the diagnosis of a molar pregnancy

usually made?

A molar pregnancy usually ends in a ‘miscarriage’ in

the first three months of the pregnancy.
The usual findings are:

 bleeding in early pregnancy

 an ultrasound which does not show a normally- Ultrasound picture of a complete molar pregnancy
developing pregnancy showing a bunch of tiny cysts.
Att: Häggström, Mikael. "Medical gallery of Mikael Häggström 2014".
Wikiversity Journal of Medicine 1 (2). DOI:10.15347/wjm/2014.008.
 other symptoms – rare these days. ISSN 20018762. - Own work
o Before the modern age of home
pregnancy tests and early ultrasound,
To make the right diagnosis, pregnancy tissue
molar pregnancy diagnosis and
should be checked under a microscope by a
treatment often happened much later
pathologist. This always happens with pregnancy
o In those cases, women would sometimes
tissue collected during curettage.
develop symptoms such as severe
vomiting, abdominal swelling, overactive
When women miscarry at home, we ask them to try
thyroid problems and other problems.
and collect the tissue they pass, so we can send it
This rarely happens these days.
to the pathologist. For an accurate diagnosis,
pregnancy tissue passed at home must be kept in
The fact is, many women don’t find out they have a
the refrigerator and brought to the hospital as soon
molar pregnancy until after the pregnancy tissue is
as possible and always within 12 hours.
looked at under a microscope by a pathologist.

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How is Molar Pregnancy treated?
If ultrasound suggests a possible molar pregnancy,
the best treatment is suction curettage. You are
asleep in the operating theatre for this short
operation. A doctor passes a narrow tube up the
vagina and into the uterus and attaches low suction
to remove the pregnancy tissue [please see our
fact sheet on curettage for miscarriage].
Sometimes molar pregnancies bleed during
surgery.
As for other miscarriages, before surgery we test
 bhCG (pregnancy test hormone level)
 blood count (to make sure you are not anaemic)
 blood group
 other tests only if needed
If you are Rh negative blood group, before you go
home we will give you an injection of Anti D. This
will prevent you from developing antibodies in your
blood which could affect future pregnancies.
Follow up after molar pregnancy diagnosis
Because of the small risk of turning cancerous, you
need to have follow up bhCG blood tests after
treatment for a molar pregnancy
 following the bhCG trend is most accurate if
each bhCG test is done by the same laboratory
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Follow up bhCG plan after Complete Molar
Pregnancy:
 bhCG blood test every week until the level falls
below 5 IU/L (< 5IU/L) for three weeks in a row.
 Then a bhCG blood test every month for 6
months from the time of your curettage.
 If the bhCG level falls below 5 IU/L within 8
weeks of your curettage (or when you
passed the pregnancy if you did not have
surgery) and remains below 5 IU/L at 6
months since the curettage, you don’t need
further tests. At this point, you can try to get
pregnant again if you want to.
BUT
 If the levels take more than 8 weeks after
your curettage to fall below 5 IU/L, the clock
doesn’t start until the bHCG is below 5 IU/L.
It must then stay below 5 IU/L for 6 months.
Only then can you stop the tests and try to
get pregnant again.
Follow up bhCG plan after Partial Molar
pregnancy:
 A blood bhCG level every week until the level is
< 5 IU/L for three weeks in a row.
 If the bHCG falls below 5 IU/L within 8
weeks of your curettage and remains below
5 IU/L for 3 results, you can stop testing.
You can try to get pregnant if you want to.
 If the levels became < 5 IU/L after 8 weeks
from your curette, then you will have follow
up as for a complete molar pregnancy.
Contraception and Avoiding Pregnancy During
Follow Up
You need to avoid pregnancy during the period of
bHCG follow up - until our staff say getting pregnant
is okay.
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This is because a new pregnancy will produce its
own bHCG, and we won’t be able to tell if the molar
pregnancy has gone away completely.
 It is best to use condoms for contraception until
the bHCG falls to normal
 If you are then having 6 months of bHCG follow
up (complete mole and also partial mole that did
not drop < 5 IU/L within 8 weeks of curettage)
our staff can help you decide which
contraception to try. You may wish to:
 continue to use condoms
 change to an oral contraceptive pill
 have an IUCD inserted once the bHCG
levels are normal, and it is more than 6
weeks since your curette
What happens if my bHCG levels don’t fall below
5 IU/L?
Sometimes the bHCG levels:
 do not fall well (fall of less than 10% over 3 x
weekly results)
 go up instead of down (rise of more than 10%
over 4 x weekly results)
This could mean you are developing persistent
molar pregnancy or, less commonly,
choriocarcinoma. We will organise
 a pelvic ultrasound
 a CT scan of your chest and abdomen
 referral to an expert in persistent molar
pregnancy because you may need some
chemotherapy.
If this happens to you, try not to worry too much.
You can be confident that chemotherapy treatment
of persistent molar pregnancy and choriocarcinoma
leads to a cure in almost 100% of cases.
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Chemotherapy should not affect your chances of
having another baby. It also does not cause
problems in future pregnancies.
What care should I take in the next pregnancy?
There is around 99% chance you won’t have
another molar pregnancy.
In any future pregnancy you should:
 have an ultrasound at about 8 weeks to make
sure the baby is growing well, and the
pregnancy looks normal
 make sure to tell your doctor that you have had
a molar pregnancy in the past
 always have a bHCG test 6 weeks after any
future pregnancy no matter how many normal
pregnancies you have. Persistent molar
pregnancy or choriocarcinoma can very rarely
pop up again after a future normal pregnancy.
Losing a wanted pregnancy is upsetting
for women and their families. A molar
pregnancy adds additional stress.
As well as the physical recovery,
emotional healing often takes time.
Talk about your feelings with your
family and friends, our clinic staff and
your GP. Let us know if you would like
to see a counsellor or psychologist.
And never blame yourself – pregnancy
loss including molar pregnancy
happens by chance. It is just bad luck
and can happen to anyone.
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