Etiology, Natural History, and Management of Recent Advances in Molar Pregnancy

Molar pregnancy is a rare reproductive anomaly that globally affects 1:1,000-1,500 pregnancies. It is caused by aberrant fertilization and can be associated with medical complications or progress to postmolar gestational trophoblastic neoplasia. Molar pregnancy presents with two distinct entities, complete and partial hydatidiform mole, which differ in their clinical, genetic, and prognostic aspects. Maternal age and history of molar pregnancy are the main risk factors for the occurrence of molar pregnancy. Early diagnosis of molar pregnancy by ultrasonography is associated with a decrease in medical complications but not decreased postmolar gestational trophoblastic neoplasia. After the diagnosis of a presumed molar pregnancy, patients should be referred to an expert with experience taking care of molar pregnancy or to a reference center for uterine evacuation and postmolar follow-up, which facilitates early diagnosis of gestational trophoblastic neoplasia. Weekly human chorionic gonadotropin measurement is essential to confirm remission and to identify cases of gestational trophoblastic neoplasia that will require further treatment. To maintain the reliability of this tumor marker, hormonal contraception is indicated during postmolar follow-up. The postmolar follow-up should extend for 1 month and from 3 to 6 months after remission in cases of partial and complete hydatidiform mole, respectively. The reproductive outcomes after molar pregnancy are comparable with those of the general population, except for the higher occurrence of recurrent molar pregnancy, affecting 1.0-2.0% of subsequent pregnancies. The considerable psychosocial repercussions of molar pregnancy require a multidisciplinary approach to minimize the repercussions of this disease on mental health.