Challenges of dealing with molar pregnancy in Tanzania

Tuesday December 19 2017
pic cover molar

Amina Salumu, 35, was two months pregnant but her belly grew big, as if she was in her second trimester. With this, she had severe nausea and severe abdominal pain including high blood pressure. She sensed something wasn’t right.
Upon attending her first clinic at the Muhimbili National Hospital (MNH), the gynaecologist advised she does an ultrasound [a type of safe and painless scanning that produces pictures of the inside of the body using sound waves] to know what the problem might be or to rule out any concerns.
That day, Amina sat in the queue for more than four hours, but she was not one among the lucky ones to get the scan done.
The following day, the case was no different. The queue and unbearable pain made her resort to a plan B. Amina decided to look for another clinic, outside the gates of MNH. She was successful to get the ultrasound done. When she took the results back to her gynaecologist, Amina was told that she had ‘molar pregnancy’, a condition she wasn’t familiar with and that daunted her.
“I was very worried about the condition. To make it worse, when I googled about the condition soon after I left the doctor’s room, I learnt that it can result to cancer and I was about to collapse. I had to wait for my husband to come for me as I couldn’t manage to go back home alone,” she recalls the four-month back incident.
Dr Living Colman, a gynaecologist based at MNH explains to Your Health that a molar pregnancy occurs when something goes wrong during the initial fertilisation process and the placenta or the foetus do not develop properly. It appears as a grape-like cluster.
“There are usually two types of molar pregnancies, complete and partial. With complete molar pregnancy, there is no baby in the uterus but only parts of the placenta are formed after the fertilisation of an empty egg.
Partial happens when the abnormal cell and embryo has birth defects. The condition is curable if there is early treatment; However, it has serious complications if not well taken care of and can result to the formation of a rare form of cancer,” Dr Colman tells.    

What steps did Amina take?
A week later, Amina went through vacuum aspiration [a suction method to remove tissues from the uterus which cost her between Sh150,000-Sh200,000. After that process she went on methotrexate medication for four weeks. Single dose went between Sh35,000-Sh70,000. And currently she is on a follow-up procedure to monitor the human chorionic gonadotrophin (hCG) levels.
“You can just imagine how expensive it is. The hCG test goes for Sh40,000. In a month I had to do four of them to ensure the mole tissue were completely removed and the blood remained clean,” says Amina.
Dr Colman adds to this. He says that it is important for the hCG levels to be monitored as it is the only way to trace if the condition has completely cured. If traces of mole remains, it can begin to grow again and create cancerous-type threat to other parts of the body.
“After the removal of the molar pregnancy, one should avoid trying to conceive at least for a year. A woman can use any birth control except intrauterine device,” Dr Colman gives a tip.
Treating molar pregnancy is very expensive and has a lot of stages to follow. If not treated on time, it can result to cancer (choriocarcinoma).
“Molar pregnancy treatment starts from diagnosis to its treatment. The pregnancy has to be removed if not miscarry as in most cases they don’t go up to five months.
If it happens there is no miscarry, a patient has to go through some medication to help the uterus release the pregnancy,” Dr Colman says.
According to Dr Colman, vacuum aspiration has to be done to remove molar pregnancy by opening the uterus and have it checked to make sure all molar tissues have been removed. After this process a woman has to go through a medication called methotrexate.

When molar pregnancy turned cancerous
Maria Joseph, 32, also experienced molar pregnancy just a month ago. With her, it took four months exactly to diagnose. She had a very big belly and sometimes would see vaginal spotting, yet she was under assumption that it was normal.
“I never took it seriously, however, the pain would come and go. When the pain was severe, I decided to go to the hospital. Though I was treated with extra care, my doctor was not happy with me for staying at home for so long without consulting him,” says Maria.
She says, same day through the ultrasound they realised it has extended to chronic molar pregnancy that left my life into a cancer stage.  I went through the vacuum aspiration. And currently I am on three types of medication, including methotrexate.
Maria regrets taking the decision late, “ I feel guilty of ignoring the early signs to a point that led to putting my life in danger.”
Maria’s single dose of medication goes for Sh100,000-Sh200,000. Each follow up check-up to observe whether molar pregnancy is successfully removed, cost her up to Sh135,000 per visit excluding other basic expenses like transportation. The hCG test, as aforementioned by Amina goes for Sh40,000. Full blood picture for Sh15,000  and other tests to check the status of vulnerable organs like liver and kidneys goes for Sh80,000.
Commenting on her treatment, Dr Colman says that if she follows doctor’s advice, she will be completely cured. The type of cancer resulted from molar pregnancy is curable only if a patient will follow treatment procedures.
“It is important for all women to attend their maternity clinics soon after they realise they are pregnant. This will help them know if they are in a good condition or not,” says Colman.

[email protected]