Inadequate intake of protein and vitamin A may be linked to abnormal pregnancies- Molar Pregnancy

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Molar pregnancy is a type of gestational trophoblastic tumour (GTT) and very rare pregnancy complication. It occurs when the normal fertilization of an egg goes wrong. It is when the tissue that was supposed to form the placenta grows abnormally and thus forms a tumor that can spread beyond the womb or uterus. This leads to the growth of abnormal cells or clusters of fluid filled sacs inside the womb. Most are not cancerous (they are benign). Even those that can spread beyond the womb are curable. 

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Most molar pregnancies are noncancerous and confined to the uterus (hydatidiform moles). If a fetus begins to develop along with a hydatidiform mole, it typically has many malformations and almost never can be delivered as a living baby. On the other hand, a more aggressive tumor associated with molar pregnancies is an invasive mole, also called chorioadenoma destruens. The invasive mole contains many villi, but these may grow into or through the muscle layer of the uterus wall. Rarely, invasive moles can cause bleeding by perforating the uterus through its whole thickness. All forms of molar pregnancy, including choriocarcinoma, are more common in women of Asian or African ethnicity.

Types of molar pregnancy
There are two main types of molar pregnancy: complete and partial molar pregnancies

Complete molar pregnancy:
In a normal pregnancy, the fertilized egg is made up of 23 of the mother’s chromosomes and 23 of the father’s chromosomes. However, in a ‘complete’ molar pregnancy, the egg contains no maternal chromosomes and only the 23 paternal chromosomes, meaning there is no fetus or amniotic sac present. The placenta is abnormal and develops rapidly, with cysts present. These cysts grow in clusters like grapes, and are visible by ultrasound.
Partial molar pregnancy
A ‘partial’ molar pregnancy occurs when there are 23 chromosomes from the mother and 46 from the father, making 69 chromosomes in total rather than the normal 46. This can occur because two sperm enter the egg and fertilized it, or because the sperm replicates itself once inside the egg. In a partial molar pregnancy there will be some normal placental tissue amongst the abnormal cells, and an embryo does develop. This may be a fetus or fetal cells, but it is genetically abnormal and not compatible with life. It will not survive longer than three months.

Causes of molar pregnancy
The cause of a molar pregnancy is an abnormality during fertilization, likely when two sets of chromosomes from the father become mixed in with either one set of chromosomes from the mother (partial mole) — or none of her chromosomes at all (complete mole). Most molar pregnancies are discovered within weeks of conception, and all end in miscarriage.

Risk factors for having a molar pregnancy
Teenage pregnancy
Being younger than 20 years old or older than 35
Previous history of a molar pregnancy
Low intake of carotene (a form of vitamin A)
Ovulatory disorders such as Polycystic Ovary Syndrome (PCOS)

Symptoms of Molar Pregnancy

Vaginal bleeding from the 6th to 16th weeks of pregnancy.
Bleeding that continues for a long time after delivery.
Continuous or intermittent brownish discharge
Nausea
Uncomfortable cramping
Unexplained weight loss
High blood pressure
Larger than expected uterus
Doughy uterus
Absence of embryonic or fetal tissue
Excessive levels of thyroid hormone
Abdominal swelling, caused by the uterus becoming larger, that occurs more rapidly than expected for the first trimester of pregnancy
Excessive vomiting during pregnancy
Fatigue, often caused by anemia from heavy bleeding
Sudden severe abdominal pain caused by internal bleeding
Pelvic cramping
Shortness of breath
Coughing or blood in coughed-up secretions

Diagnosis
These are the conditions that may inform the doctor to suspect you have a molar pregnancy:
Symptoms presente- largeness of your uterus , high level of human chorionic gonadotropin (HCG)
Through Pelvic ultrasound
Through X-rays, computed tomography (CT) scans or magnetic resonance imaging (MRI) scans to view the chest, abdomen, pelvis and brain.

Treatment
Surgery to remove the tumor.
Suction dilation and curettage (D and C)
Removal of the uterus (hysterectomy)
Chemotherapy with a single drug to treat tumors with good prognosis
Chemotherapy with multiple drugs is generally required to treat invasive tumors with poorer prognosis.
Radiation treatment: it is the use of high-strength X-ray beams to destroy cancer cells in the exceedingly rare case when a tumor has spread (metastasized) to the brain.

Duration of treatment and time of next pregnancy
Treatment for some molar pregnancies can take several months. Following treatment, you will need to have repeated blood tests and checkups over one to two years, to be sure that all molar tissue has been treated and that the problem has not returned.

Pregnancy after treatment
Your practitioner will probably suggest that you should not get pregnant for 6 months to a year (women who try to conceive sooner are at greater risk for having another). The good news is that otherwise, having one molar pregnancy is not an indication that you have a higher risk for having another one. Only 1 to 2 percent of women who have had one molar pregnancy go on to experience a second. While you are recovering, make sure to eat a balanced diet, since some research has shown that inadequate intake of protein and vitamin A may be linked to such abnormal pregnancies.

Prevention
Start prenatal care in the first trimester, with regular checkups from a qualified health care professional, so that problems can be identified as early as possible.

Seeking Medical help
Call your prenatal care provider if you experience any of the symptoms listed above. Since some of these symptoms can be difficult to differentiate from normal early pregnancy signs and symptoms (many completely normal pregnancies include some spotting and cramping, and most include nausea), you should trust your instincts. If you think something is wrong, talk to your provider.

Prognosis
With appropriate treatment, all hydatidiform moles are curable, and nearly all cases of more aggressive molar tumors can be cured. Even with tumors whose features categorize them as having a poor prognosis, 80% to 90% are cured with a combination of surgery and, if needed, chemotherapy.

It is important for women with molar pregnancies to be evaluated periodically after the problem has been treated. Women are advised not to attempt pregnancy for some time in order to be sure that levels of HCG remain at zero and that no further treatment is needed. There is a risk that a molar pregnancy can come back after treatment. Recommendations are changing and vary by hospital. It is usually possible for women to have a normal, healthy pregnancy after treatment for a molar pregnancy.

 



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