Surgery for molar pregnancy

After a diagnosis of molar pregnancy, the molar tissue needs removing from the womb. Most women who have a molar pregnancy have surgery. It is used to:

• confirm the diagnosis of a molar pregnancy 
• remove the molar tissue

There are different types of surgery used to remove the molar tissue.  

Most women will have dilatation and suction evacuation (D and E) or dilatation and curettage (D and C). But your surgeon might advise you to have an operation to remove your womb (hysterectomy) if:

• the molar pregnancy is causing a lot of bleeding from your womb
• you already have a condition of the womb, such as fibroids
• you don’t want to have any more children

Before the operation

You might have some tests such as blood tests, a heart trace (ECG) and a chest x-ray.

A member of the surgical team will tell you about your operation and what to expect afterwards.

Your nurse will check your:

• weight
• blood pressure
• pulse
• temperature

Your nurse might give you a tablet or an injection to help you relax. This will be an hour or so before you go to the operating theatre. This makes your mouth feel dry but you can rinse your mouth with water to keep it moist.

You have your operation under general anaesthetic. The anaesthetist puts a small tube into a vein in your arm (cannula) and injects the general anaesthetic. This sends you into a deep sleep. When you wake up, the operation will be over.

Dilatation and suction evacuation or dilatation and curettage

The surgeon opens up (dilates) the entrance to the womb (cervix). Then uses gentle suction to remove as much of the molar tissue as possible (D and E). 

The surgeon might then use a small instrument called a curette to scrape the lining of the womb and clear away any remaining molar tissue (D and C).

You have an ultrasound at the same time, so the surgeon can see the abnormal tissue. The tissue is sent to the laboratory for checking.

After your operation

You stay in hospital for at least a few hours or overnight. 

You will have some bleeding for up to 2 weeks. It might be heavy and red at first. Let your doctor or specialist nurse know if the bleeding doesn't slow down or if it gets heavier.

For 2 weeks after the operation you should avoid:

• having sex
• using tampons
• using very scented soaps

This is to avoid the risk of infection.

Hysterectomy

Your surgeon removes your womb and cervix. This is called a total hysterectomy. There are different ways your surgeon might do this. They are:

• open surgery – through one large cut in your tummy 
• laparoscopic (keyhole) surgery – through a few small cuts on your tummy 
• vaginal surgery – through a cut inside your vagina

The tissue that is removed is sent to the laboratory for checking.

After your operation

You usually go home between 4 and 7 days after surgery. You will need to rest for about 4 to 6 weeks after you come out of hospital.

During this time, you won't be able to:

• do heavy housework, such as vacuuming
• carry heavy bags of shopping or washing
• drive

This is because all these activities put pressure on your abdominal muscles and skin. These need time to heal. It will take longer to get over your operation if you put too much strain on this area.

You will gradually be able to increase the amount you can do. Your nurse and surgeon will advise you about this.

Follow up tests after your surgery

For most women, the surgery removes most of the molar tissue and any remaining cells die off on their own. So you don’t need any more treatment. But sometimes the few cells remaining in the womb, or elsewhere in the body, carry on growing after the surgery.

You need to have regular follow up to make sure you have no signs of remaining molar tissue after your surgery. Molar tissue produces a hormone called hCG. So you have regular blood or urine tests to check the levels of hCG.

If your hCG levels stay high or they go up, it is called an invasive mole or persistent trophoblastic disease (PTD). You might need to have chemotherapy treatment. Very rarely, you might have a second operation to remove the remaining cells.

About 13 to 16 out of every 100 women (13 to 16%) who have a complete molar pregnancy will need treatment with chemotherapy as well as their operation. 

About 1 out of every 100 women (1%) with a partial molar pregnancy will need chemotherapy.

How you might feel

It’s not easy to deal with a molar pregnancy and you might have very strong emotions that feel overwhelming. Your nurse or midwife will support you and offer some options for counselling and support.