I realized that I really never explained what on Earth this type of pregnancy is.  I don’t even know if anyone *wants* to know, but I figured I’d explain it and provide a few links, just to clarify.  (We have spent hours scouring the web for information about it, and it is, frankly, really hard to come by.  There is no way around this:  this is a fairly rare pregnancy outcome.)

So this pregnancy was a partial molar pregnancy, or a partial hydatidiform molar pregnancy.  There are two types of molar pregnancies:  complete moles, and partial moles.  In the complete mole, there is no genetic information in the egg, and the sperm fertilizes it and makes a copy of its own genetic material, so there are 46 chromosomes, but they are all from Mr. Swimmer.  That type of pregnancy develops into a massive placenta that looks like a snowstorm on an ultrasound, and there is no baby or fetus present.

In a partial molar pregnancy, the egg has genetic material, but for some reason, the egg never signals to the other sperm that it has been fertilized, so two sperm (eagerly?) fertilize the egg.  (This is thought to be an egg dysfunction.  I thought I’d spell it out for you.  Yes, that would be *MY* egg dysfunction.  You cannot find that anywhere in the medical literature.  I had to ask my doctor, who has devoted his life to this issue, to clarify that for me.)  The fetus then has 69 chromosomes (triploidy), rather than the normal 46 (or liveable, but not typical, 47).  Having 69 chromosomes is absolutely fatal.  There are cases where a baby has survived with 69 chromosomes, but s/he typically does not live very long.

In a lot of the literature online, it says that there is no heartbeat present for a PMP.  I don’t know how accurate that is.  We saw a healthy, strong heartbeat twice on ultrasound and made it to the second trimester with what we thought was a healthy, normal-looking baby.  By the time we had found out there was no heartbeat, I do not know if the baby looked abnormal (it looked like a dead baby to me, but then again, I am not really looking at lots of ultrasound pictures of alive or dead babies these days).  I know that the placenta, by THAT time, looked abnormally large.  That was what our doctor told us was suggestive of a molar pregnancy – that the placenta looked strange (I don’t know if she was just sparing us the misery of knowing our baby was odd, too, is what I’m saying.  Does that make sense?).

So the symptoms of a molar pregnancy include abnormally high hCG (pregnancy hormone) levels, which come with more intense nausea/vomiting, early expansion of the uterus (so one looks further along than one actually is), ovarian cysts (there are typical pregnancy ovarian cysts that support a healthy pregnancy, and there are cysts that are not normal from high serum hCG), and some other symptoms that I didn’t experience whatsoever, like bleeding.  If you read through some of my earlier posts about “popping”, and the daily puking update, you will see that early on, I had some of these symptoms – but I had no idea that they meant my baby wasn’t right.  Plus, I have lots of friends who are also very nauseated in pregnancy – I thought that it was normal to throw up multiple times a day.  (And their babies are alive and healthy now!)

The cancer issue:  what on Earth am I talking about?  Well, a molar pregnancy is a form of gestational trophoblastic disease (GTD).  Because the placenta is this strange mix of chromosomes, it really buries itself into the uterus.  Molar pregnancies are almost always evacuated by a D&C (dilation and curettage).  Most of the time that tissue is evacuated entirely, but sometimes it isn’t, and the placenta material left behind can act like a tumor.  It continues to produce hCG, and if it is left unchecked, it can metastasize to the lungs (most common), GI system, or brain.  So although all women who have a D&C generally have a quantitative hCG test to ensure that there is no residual tissue left behind (I hate the term “products of conception”, but in this case, that’s really what it is), for molar pregnancies, women must have weekly hCG tests to ensure that their hormone levels are going down.  If the hCG levels go up or plateau (less than a 10% change from week to week), they either have a second D&C or start chemotherapy to prevent the tissue from metastasizing.

The goal is to have zero hCG, which is defined by a score of <5 or <2, depending on the lab.  (For me, it is less than 5.)  Once I have three weeks where I have zero consecutively, I switch to monthly blood draws, and then after three months of zero hCG on THAT, we can consider trying to conceive.  That decision is on hold and I probably won’t blog about that here.

There are a lot of things that say that a couple cannot TTC until the woman is clear for 6 months, or 12 months.  Those are dated statistics, and better research indicates that three months is a safe amount of time for a woman to wait to conceive.

The reason one NEEDS to wait is because in pregnancy, the hCG levels in a woman’s blood begin to double from the moment of (implantation?) – so all of a sudden, hCG levels rise.  At that point, it is impossible to tell if she is fighting cancer or growing a baby, and the woman’s health is at risk.  Although this is a very treatable (approaching 100%) cancer, it is not so treatable if one is also trying to support a baby.

So essentially, this sucks.  🙂  Can I say that?  This is kind of like a double whammy – we made it through the first trimester, then lost the baby, then lost a lot of blood, then lost a lot of time, and now we’re waiting to be sure that I don’t have uterine cancer.  Talk about getting more than we bargained for.  Last week, I was quite certain that I would have to have chemo, because my hormone levels were so very high.  This week, in the greatest news of the last month, they look to be about where we could expect a normal post-D&C PMP to be.  THAT is a huge blessing for so many reasons – not only the cancer, but also because having high hCG levels means that one also has lots of pregnancy symptoms.  It is such a painful reminder of what once was, to have heartburn, to be throwing up, to be craving something, totally constipated, or waking up totally congested.  You know, the joys of the first trimester…sans baby.  It’s been a month since the D&C, and I can honestly tell you that I have only had about 5 days without a lot of those symptoms.  That is really emotionally painful.

So if you are wondering how to pray, well, we are just praying that God opens a door somewhere, and we are praying to feel at peace with all of this.  I usually don’t pray for THINGS, but these days, I am also praying that the levels go down, and go down quickly.  So far, so good 🙂  but I want to also say that if the levels had gone UP, I wouldn’t be questioning whether God was listening or not.

Sometimes that is a tricky line to walk.

Here are two articles on line that are also good sources of information:

http://emedicine.medscape.com/article/254657-overview

http://www.obgyn.net/women/women.asp?page=/women/articles/molarpreg_dah

And just to clarify – this was a freak thing, although we have a higher chance of having another molar pregnancy given this one (originally it is 1/1000 pregnancies; now we have a 1% chance of having a second).  However, it doesn’t make it any easier.  To us, this was a baby, and it was a loss, and this additional anxiety is like rubbing salt onto a wound.  Although it is true that my antibodies did not kill the baby – and for that I am really, honestly, relieved – we have enough else going on that really, that reality is diminished.  Perhaps I will be more appreciative of the randomness of this…later.

I am intentionally unpasswording this.  I will be changing the PW for this blog after this.  If you’ve never commented before, and still want the PW, now is the time to make yourself known.  (If you are a regular commenter, don’t worry about it – I will email you directly.  You don’t need to come up with something here to get the PW!  :))

For those who might come here because they also have a molar pregnancy, feel free to email me.

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