Wine pregnancy: signs, causes and treatment

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What is wine pregnancy?

According to the Mayo Clinic, wine pregnancy (molar pregnancy) is a pregnancy complication characterized by the development of a benign (noncancerous) tumor or cyst in the uterus.

In medical terms, this condition is called a hydatidiform mole. "Hydatid" means a sac or cyst filled with fluid, while "mola" means a mass of cells. Sometimes this condition is also referred to as trophoblast disease.

Women who experience molar pregnancy shows a positive result pregnant on test pack and continue to experience general pregnancy symptoms.

However, what develops in the uterus is an abnormal growth of tissue typical of a tumor or cyst, not a fetus. That's why this condition is also known as "false pregnancy".

Hydatidiform mole is a pregnancy complication that can be life threatening. So, you need proper medical care and treatment in order to get pregnant again.

How common is wine pregnancy?

This condition is quite common, but the risk and number of cases will vary depending on geographic area and ethnic group.

In Southeast Asia and Indonesia itself, this condition of pregnancy is quite common. General statistics estimate that 1 in 500 pregnancies is a hydatidiform mole.

The risk will increase at the beginning and end of a woman's childbearing age. The highest risk if pregnant in adolescence (under 16 years) and pregnant at the age before menopause (more than 4o years).

Grape pregnancy cannot be saved because the fertilized egg does not succeed in becoming an embryo. The doctor will take special care to remove the abnormal tissue.

What are the signs and symptoms of wine pregnancy?

At first, molar pregnancy shows general pregnancy symptoms. However, there are several other characteristics that indicate this condition, including:

• Pelvic pain
• Nausea and vomiting that is worse than normal pregnancy
• Bleeding accompanied by a collection of grape-like lumps that come out of the vagina.
• Early preeclampsia in the early weeks of pregnancy.
• Increased levels of hCG
• There are no signs of life in the fetus
• The size of the uterus is not normal and does not match the gestational age.
• Hyperthyroidism (the thyroid gland is overactive and overproduces the hormone thyroxine)
• The appearance of ovarian cysts
• Symptoms of hyperthyroidism such as fatigue, nervousness, irregular heartbeat, and excessive sweating
• Discharge from the vagina
• Anemia in pregnant women

After a positive detection of molar pregnancy, these tissues will be removed by medical surgery so that nothing is left in the uterus. This is done to prevent continuing complications.

Even if the symptoms you are experiencing are not detected as false pregnancy, but you have a miscarriage in the first 20 weeks of unknown cause, this will often be indicated as hydatylose molars.

Miscarriage within 20 weeks is common as a response from the body to terminate a troubled pregnancy.

When should I see a doctor?

You should immediately check with your doctor when experiencing normal symptoms of pregnancy in general. The doctor will check and confirm pregnancy.

When experiencing any signs of pregnancy you should contact your doctor. Especially if you experience further symptoms of wine pregnancy such as:

• The rapid growth of the uterus can be seen from the enlarged belly of the mother in the short term.
• Abnormally high blood pressure
• The appearance of protein in the urine after 20 weeks of pregnancy
• Have anemia
• Have hyperthyroidism, including anxiety / nervousness, excessive sweating, or too fast metabolism.

This pregnancy condition is arguably fatal and requires immediate treatment.

Cause

What causes wine pregnancy?

There are several conditions that cause hydatilose mole, namely:

The sperm did not fertilize the egg properly

This condition initially goes through the fertilization process between female egg cells and male sperm cells. However, the abnormal fertilized egg develops into a tumor, not a fetus.

Wine pregnancy can also be caused when the sperm do not fertilize the egg properly. Finally, the cluster of cells that should be able to form the placenta changes to form abnormal tissue.

In this condition, tissue filled with fluid will grow to fill the space in the uterus, not the fetus. These fluid-filled cells are called trophoblasts.

The growth of benign trophoblast tumors can still trigger pregnancy symptoms. That's why so many women think they are pregnant when they are not.

Chromosomal abnormalities

Some other possible causes are chromosomal abnormalities. This condition can occur when the amount of genetic material in a fertilized egg is not correct.

Human cells normally contain 23 pairs of chromosomes, one set from the mother and the other from the father.

The genetic structure of these chromosomes carries information that tells the cells of the body what to do.

In wine pregnancy, there is an additional set of chromosomes that come from the father. When this happens, the fertilized egg cannot survive and eventually dies a few weeks after pregnancy.

Two types of wine pregnancy are differentiated according to their causes

This condition has types that are distinguished by their cause, namely.

Causes of complete wine pregnancy (complete molar pregnancy)

To become a fetus, normally 46 complete chromosomes are needed. Namely, 23 pairs of chromosomes come from the sperm and 23 pairs of chromosomes come from the egg.

While complete wine pregnancy occurs when an egg without genetic content is fertilized by sperm. This condition results in the fetus not developing in the womb.

However, in women with this condition, an error occurs in the fertilization process of the chromosomes.

The chromosomes from the egg and sperm fail to unite. As a result, there are only 23 pairs of chromosomes from the egg, so the egg cannot survive and die.

Even though the egg dies, the trophoblast (part of the placenta) will continue to grow and form a fluid-filled cyst. So, what is formed is a cyst (tumor), not a fetus, which is called wine pregnancy.

Causes of partial wine pregnancy (partial molar pregnancy)

Partial false pregnancy occurs when two sperm that do not contain chromosomes at all fertilize an egg.

This can cause the fetus to develop abnormally so that the fetus cannot survive.

It is not only the chromosomes that fail to unite, the excess number of sperm at conception can also be the cause of false pregnancy. The number of chromosomes should be 46 pairs, so that's more than the number needed.

Although the fetus can form, the abnormal development of trophoblasts can be an obstacle for the fetus to develop. As a result, babies can experience birth defects.

Risk factors for wine pregnancy

There are many factors that increase a woman's risk of developing a hydatidiform mole, namely:

• At the age of pregnancy, women who are pregnant above 35 years or under 20 years are at a higher risk.
• Never been pregnant with wine before.
• Had a miscarriage.
• Asian ethnic women experience this condition more often.
• Lack of intake of carotene, another form of vitamin A.

Women who don't get enough vitamin A are at a higher risk of developing a complete wine pregnancy.

Complications of wine pregnancy

What are the complications that can arise?

Grape pregnancy diagnosed early will generally not cause any health effects.

However, if the diagnosis is late and is not treated promptly, this pregnancy problem can lead to the following complications:

1. Bleeding

Grape pregnancy can cause bleeding that comes out of the vagina. Bleeding can be in the form of blood clots or watery brown vaginal discharge.

The discharge is not completely blood, but also includes pieces of tumor tissue that can look like tiny grapes.

Vaginal bleeding caused by molar pregnancy (wine pregnancy) usually begins between the 6th to 12th week of pregnancy.

2. Preeclampsia

The body of a woman who is pregnant with wine will process certain substances in the blood.

These substances can increase blood pressure, then affect the work of the kidneys and sometimes even liver function. The condition of high blood pressure during pregnancy is a sign of preeclampsia.

3. Persistent GTD (g estational trophoblastic disease)

Sometimes after the molar pregnant tissue (pregnant wine) is removed through a curettage process, there may still be some residue left in the uterine cavity.

The remaining cells usually go away on their own within a few months, but otherwise this results in the condition called persistent GTD (g estational trophoblastic disease).

Persistent GTD is characterized by an increase in the amount of the hormone hCG even after curettage. Roughly 1 in 7 women who are completely wine pregnant and 1 in 200 women who are partially pregnant develop this complication.

If persistent GTD spreads to other organs, this condition can be diagnosed as cancer and requires chemotherapy for several months.

Most women with this condition will be treated with a combination injection of the drug methotrexate and folinic acid.

However, if it does not go away after that, it needs further treatment according to the doctor's plan.

4.Choriocarcinoma (Choriocarcinoma)

Choriocarcinoma is a type of cancer that can occur in the lining of the uterus. Choriocarcinoma can occur after a normal, healthy pregnancy.

Most of the cariocarcinomas occur and are related to previous pregnancy.

What is the impact on the uterus?

When you experience it, you will be advised not to get pregnant for a few months to a year until completing a hormone monitoring program.

After the operation to remove the abnormal tissue, in some cases, there is still tissue left in the body.

This tissue often continues to develop gestational trophoblastic disease (an abnormal pregnancy due to a malignant tumor). This incident can occur in 1 in 5 women.

Gestational trophoblastic disease can still be treated with chemotherapy.

You may still get pregnant about a year after completing chemotherapy or by removing the uterus for those who are no longer planning to become pregnant.

Its malignant nature makes this gestational trophoblastic disease the potential to trigger cancer.

This is very possible, but very rare and in some cases can still be treated with a combination of several cancer treatments.

Diagnosis of wine pregnancy

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

Diagnosis of wine pregnancy can be known as early as possible. However, usually caught at 8 or 9 weeks of gestation via ultrasound.

At this gestational age, the doctor will perform an ultrasound examination as follows:

• The presence or absence of an actual embryo or fetus
• No amniotic fluid (amniotic) or very low amniotic fluid
• Cystic placenta that fills the uterus
• The presence of ovarian cysts
• There is a fetus but growth is limited (in partial wine pregnancy)
• Other uterine examinations using X-rays, computed tomography (CT) or magnetic resonance imaging (MRI) if suspected cancer may have spread to other areas of the body.

To suspect wine pregnancy, the doctor must find clear symptoms. However, diagnosis it may be more difficult if you have the following conditions:

• Never been pregnant in a healthy and normal state without any problems
• Have had a miscarriage but do not know the cause of pregnancy in wine or not

To be sure, a tissue sample in the uterus must be tested in a laboratory.

Treatment for wine pregnancy

Hydatidiform mole or wine pregnancy can be treated through these procedures:

1. Using drugs

If the abnormal cells in the uterus grow large and cannot be removed with tools, the doctor will prescribe medication.

Medication will be given to make the uterus contract, so that its contents can be expelled through the vagina.

2. Dilation and curettage (D&C)

Dilation is the process of dilating the cervix because the mother's cervix cannot open on its own.

After opening, then curettage or tissue removal in the uterus is carried out to clean the remaining wine pregnancy.

After that, the level of the pregnant hormone hCG in the blood will be measured to determine whether the hydatid mole (wine pregnancy) has been completely removed.

3. Hysterectomy

This procedure is done by operating and removing the uterus to be removed from the body.

The main reason women have to have a hysterectomy is because they have a medical problem that requires having their uterus removed.

Whichever solution your doctor recommends, you may still need to undergo follow-up examinations for 6 months to 1 year.

You also need to consult your doctor before planning to become pregnant again.

3. Monitoring HCG

After the molar tissue is removed, the doctor will usually continue to measure the hCG level until it returns to normal. This test can be done by examining urine and blood.

hCG is a hormone produced by the placenta during pregnancy. However, this hormone can also be produced when abnormal tissue grows in the uterus, such as in the case of wine pregnancy.

If the level of hCG in the blood is still detected, this is a sign that there is still molar tissue remaining in the uterus.

In certain cases, abnormal wine pregnancy cells cannot be lost, even after various treatments have been carried out after wine pregnancy.

This condition, known as persistent trophoblast disease (PTD), affects 15 percent of complete molar pregnancies and 0.5 percent of partial grape pregnancies.

If not treated immediately, this disease can spread to other parts of the body like cancer.

Doctors will usually give oral medication folinic acid or methotrexate injection to help kill these abnormal cells for several months.

Doctors will usually monitor HCG levels for 6 months to 1 year after treatment.

The condition of each woman is different, so the method of treatment for wine pregnancy can be different in each case.

Home remedies

Various home remedies that can be done, namely:

Make peace with the condition of your new pregnancy wine

Wine pregnancy or pregnancy without a fetus will certainly disappoint the heart of every woman or partner.

How not to disappoint, with pregnancy symptoms and a positive pregnancy test, surely you have imagined pregnancy and becoming a mother later.

Not infrequently, many couples are mourning the condition of this wine pregnancy. It takes a process to get back up from the depression of losing a child and trying to get pregnant again.

During the process of cell cleansing, medication, therapy, and waiting periods to get pregnant again, women and their partners can be stressed.

It is important not to feel this disappointment, sadness, and anxiety alone.

It needs to be instilled too, that most patients with successful treatment of molar pregnancy can later deliver healthy babies without problems.

Remember that a molar pregnancy (wine pregnancy) has no impact on your future fertility and most women go on to have healthy pregnancies afterwards.

To be able to deal with the sadness caused by this condition, you can find a support group that has the same pregnancy problems as you.

Later you and the support group or community will share stories of problems and try to recover together.

If feelings of disappointment cannot be contained, it is advisable to contact a psychologist or psychiatrist who can restore your emotional condition after becoming pregnant.

When can you try to get pregnant again?

After experiencing wine pregnancy, surely you are wondering when to get pregnant again. You still have the opportunity to have a normal, healthy pregnancy in the future.

This condition should not cause problems for long-term physical health. The risk of recurrence of pregnancy in wine is only about 1-2 percent.

To get a normal and healthy pregnancy, it's a good idea to follow your doctor's care and medication regularly.

However, to try to get pregnant again, you have to wait until your body's hormones return to normal.

You are advised not to try to get pregnant for the first six months of the curettage operation because the molar pregnancy is successful.

Trying to get pregnant again is not advisable just yet if you have additional medical therapy.

Can wine pregnancy be prevented?

Quoting from the Cleveland Clinic, there is no way to prevent wine pregnancy. However, there are several things you can do to reduce the risk, such as:

1. Give pause for a year before trying to get pregnant again

The remnants of the pregnant wine tissue will raise the levels of HCG, aka the pregnancy hormone.

If you get pregnant before a one-year break, your doctor will find it difficult to detect whether the increase in HCG levels is due to a normal pregnancy or even abnormal tissue remnants from a previous pregnancy.

If you want to have normal success with pregnancy, it's best to wait a year before trying to get pregnant again.

Your doctor will monitor your HCG levels once a month for one year. This is done to ensure that there is no longer any remaining tissue that does not grow due to a failed pregnancy.

2. Avoid getting pregnant at old age

In addition to being full of pregnancy risks, being pregnant at an old age (over 40 years) increases the risk of recurrent pregnancy.

Before deciding to get pregnant or have another child at an age that is no longer young, you should first consult with an obstetrician.