Hydatidiform mole is a rare complication of pregnancy, estimated in France at around 1 in 1000 pregnancies. In a video published on Instagram, Dr Olivier Marpeau aka @mon.gyneco recalls that it remains little known, even though it requires a precise diagnosis, biological monitoring and appropriate support.
What is a hydatidiform mole?
A hydatidiform mole is part of gestational trophoblastic diseases. It is linked to a abnormal development of placental tissuethat is to say trophoblast, this tissue which normally participates in the formation of the placenta. In the video, Dr. Olivier Marpeau explains that the starting point is an anomaly at the time of fertilization, with abnormal proliferation of the trophoblast.
This is not a fault, nor is it risky behavior on the part of the pregnant person. It is a rare biological abnormality of pregnancy that can be difficult to understand because it often occurs early on.
We distinguish two main situations:
- In a complete mole, there is no identifiable embryo;
- In a partial mole, an abnormal embryo may develop transiently, but it is not viable.
In both cases, the pregnancy cannot progress normally.
How do we suspect it? The specialist cites two common circumstances: an early ultrasound or bleeding at the start of pregnancy. This bleeding during pregnancy can have many causes, some of which are benign, but it warrants medical advice. The dosage of beta-hCG can also guide, because it is often high in this context.
Important point: ultrasound and hCG above all allow us to suspect the diagnosis. According to the recommendations, confirmation is based on anatomopathological analysis evacuated tissues, with a specialized rereading when a mole is identified. In other words, the ultrasound image alone is not enough to conclude everything.
Why follow-up after evacuation is essential
Treatment is generally based on uterine evacuation by aspiration under ultrasound control, in a suitable medical setting. The video emphasizes the importance of this step for processing and allowing analysis in the laboratory. However, there are very specific situations which require a medical discussion on a case-by-case basis: this general information should therefore not be transformed into an individual rule.
After evacuation, monitoring does not stop. The hCG level should decrease until it normalizes. This monitoring is used to verify that abnormal trophoblastic tissue does not persist. It also makes it possible to detect a possible evolution towards a gestational trophoblastic tumor, a rare risk but more common after a complete mole.
A common confusion must be avoided: a hydatidiform mole does not automatically mean cancer. Certain tumor developments exist, but they are precisely monitored by hCG and managed according to the level of risk. For low-risk forms, adapted chemotherapy, often based on methotrexate, can be used.
The question of a new pregnancy is often very sensitive. The video mentions a delay after a complete mole, but the current benchmarks are more nuanced: a new pregnancy is usually delayed until hCG monitoring is completedaccording to the instructions of the specialized team. The objective is to prevent a new pregnancy from masking a possible resumption of the disease.
In practice, the people concerned can rely on several relays:
- The gynecological or obstetrical team which ensures diagnosis, evacuation and follow-up;
- The Reference Center for Trophoblastic Diseases, based in Lyon, which the expert presents as a resource to guide cases and follow-up;
- The Support Association against Trophoblastic Diseases, cited in the video, which supports patients faced with these diseases.
For any questions after an abnormal start to pregnancy, the good reflex remains to ask the medical team what the monitoring schedule is, when the hCG should be checked and which specialized structure to turn to. Monitoring must be personalized, without stopping or modifying treatment without medical advice.