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. This is to:

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

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 children in the future

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. They will ask you to sign a consent form. This is a good time to ask any questions you may have.

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 usually go to the recovery area. You stay there for a while until you are well enough to go back to the ward. Your nurse checks your blood pressure, pulse, breathing rate, and the amount of oxygen in your blood.

When you are well enough, you will be taken back to the ward. Your nurse continues to check you. These checks become less frequent as you recover.

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. Or if you have a vaginal discharge that smells bad.

You might also have cramp like discomfort or pain in your tummy. Your nurse will explain what you can do to help relieve the pain.

For 2 weeks after the operation you should:

• avoid having sex
• avoid using tampons
• use plain, unscented soap or shower gel (avoid heavily scented products)

This is to avoid the risk of infection.

Your nurse will also give you a contact number to call if you have any questions or concerns about your operation when you are at home.

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 should avoid:

• heavy housework, such as vacuuming
• carrying heavy bags of shopping or washing
• driving 

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.

Your nurse will explain more about your recovery and what to expect after your surgery. 

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 (about 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 (about 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. 

You might feel very upset, tearful, or low in mood afterwards. This can be due to the anaesthetic, the operation, or how you're feeling about what’s happened. 

Your nurse or midwife will help. They can talk to you about options for counselling and support.