Feedback: A Pro-life Doctor’s View on Molar Pregnancies

I have a question for you. I’m hoping you can help me out. I read Ken Ham’s article about the “after birth abortion” paper that came out. What a slippery slope we are on. But can you help me on a somewhat related topic? Molar pregnancy… I just became aware of this medical issue but I can't find any information on it that has been written from a pro-life stance. Everything I am finding states that the so-called fetus would never live and that it causes harm to the mom so it must be terminated. I became aware of this when a friend told me her relative was told she had to have her 17 week pregnancy terminated because they determined it was a molar pregnancy. The baby was aborted one day after they found out the gender of the baby. It seems to me that if there is a gender then it is a developing baby, not just a cancerous mass. Any input would be appreciated, because I know in my heart there is more to it and has to be other options. My friend is also upset about it.

– Becky, AZ

Dear Becky,

Thank you for coming to us for more information about this. I’m afraid this is a situation in which the correct medical terminology causes heartache and confusion. First of all, let me assure you that the “pregnancy” you describe sounds like a classic molar pregnancy from which there was never a possibility of having a baby. Although molar pregnancies can masquerade as normal pregnancies for a while, they are eventually found to consist primarily of a massive abnormal overgrowth of placental-type tissue in the uterus. Because that tissue produces the same hormonal signals as a pregnancy, a woman and her doctor may have no clue for some time that there will be no baby.

Molar pregnancies result from abnormal fertilization. Several sorts of abnormalities can occur, but none produce a viable fetus. Sometimes a patient is told the pregnancy “was a girl” because the genetic makeup is 46XX. However, no embryo forms. Even those molar pregnancies in which an embryo forms for a time will have a genetic abnormality incompatible with life—usually triploidy with three full sets of chromosomes. What is removed from the uterus in the case of a molar pregnancy is an accumulation of abnormal placental tissue and the remains of any embryo that may have formed. (There are very rare cases of a molar pregnancy coexisting with a normal twin, but these are recognized on ultrasound, typically monitored very carefully, and would not be confused with an ordinary molar pregnancy like those we are discussing here.) It is important for pro-life people to understand that a molar pregnancy is not a situation in which a patient has the option of having a child with a birth defect. Molar pregnancies do not produce living babies.

Furthermore, if left untreated, molar pregnancies are dangerous. Molar pregnancies are often “cured” by removal of this abnormal placental tissue from the uterus. However, in some cases they can persist and even lead to choriocarcinoma, a kind of cancer. Molar pregnancies can also cause other dangerous complications, such as high blood pressure (toxemia). For these reasons your friend was told that she was in danger if the molar pregnancy was not terminated. Notice that the terminology for ending a pregnancy, even one in which a fetus is already dead or not even present—like this one—is abortion or pregnancy termination. Again, the correct medical terminology can be distressing and confusing.

While the sort of cancer associated with molar pregnancy is generally treatable, patients who have had a molar pregnancy are monitored carefully for some time after the termination. That way, if molar tissue persists or cancer develops, it can be detected. Blood levels of the hormones associated with pregnancy are checked regularly, and patients are told to avoid getting pregnant for a period of time. Both normal pregnancy and a persistent molar pregnancy or cancer would produce the same hormone, so pregnancy is best avoided until the time of danger is past. After that, she should be able to get pregnant without any unusual risk to her baby.

Thank you again for your concern both for the lives of the unborn and for your friends. It may be that in their grief and disappointment they will derive some comfort from understanding the actual nature of what is commonly called a molar pregnancy.

Dr. Elizabeth Mitchell

Addendum

Since initially posting this article, we have received some great feedback from multiple readers. Thank you all for letting us know that this information has been encouraging and helpful, and thank you also for your follow-up questions. Especially for those who have experienced this sort of loss, I know that nothing takes away that pain, but sometimes a clearer understanding helps. Thanks for letting me know it has.

1. The “17 weeks” date is simply the calendar date for the pregnancy (in other words, about 17 weeks since the last menstrual period). This is a very common time to discover a molar pregnancy since it can masquerade as normal pregnancy for a while. Often, a routine exam at this time, failing to find a heartbeat, will prompt an ultrasound that gives the diagnosis. On ultrasound, a molar pregnancy consists primarily of abnormal placental tissue shaped like clusters of grapes, and the diagnosis is then clear.
2. In ordinary pregnancies, gender is often known from ultrasound. Women who have genetic amniocentesis also know the gender from the karyotype (DNA analysis) of the baby. However, in the case of a molar pregnancy, reference to gender is almost meaningless. (Some caregivers feel reference to “the baby’s gender” is more comforting to grieving parents who, regardless of the status of the pregnancy, are generally devastated at this news.) When the DNA analysis of the molar pregnancy is 46XX, the pregnancy is called a “complete mole” and no embryo forms at all. In fact, there is generally no maternal DNA present. These are thought to result from fertilization of an “empty egg” with duplications producing the 46XX karyotype that we normally associate with “a girl.”
3. The situation with an ectopic pregnancy is also obviously distressing. In most cases, the ectopic implantation has already resulted in embryonic death by the time diagnosis is made and removal done. Yet even in those instances in which the diagnosis is made before that time, an ectopic pregnancy—particularly in the fallopian tube—is unquestionably a life-threatening situation, and it must be dealt with to protect the mother. Tubal pregnancies generally rupture and hemorrhage if not removed, and of course the tiny baby cannot achieve the sort of implantation required. As a physician who has had to remove a living well-formed embryo from a fallopian tube, I can report that nurses and doctors alike are saddened but recognize the necessity of saving the mother’s life and the impossibility of saving the baby’s. (Patients occasionally ask if the pregnancy can be implanted correctly and live, but the answer is “no.” Implantation must happen in the uterus while the pregnancy is at the correct stage, as demonstrated by the precise timing followed in IVF clinics for embryo transfer.) You are absolutely correct in pointing out that the parents grieve at this loss, regardless of the timing of things. I used to give my patients grieving over the loss of any sort of pregnancy a little book called I’ll Hold You In Heaven and recall that our Lord Jesus, referring to little ones, did say in Matthew 18:10, “I say to you that in heaven their angels always see the face of My Father who is in heaven.”

Hope this helps.
Elizabeth Mitchell, MD

This information is intended for general education purposes only and is not intended as professional medical advice. The information should not be relied upon as a substitute for medical advice from your doctor or other healthcare professional. If you have specific questions about any medical condition, diagnosis, or treatment, you should consult your doctor or other healthcare provider.