What happened to molar pregnancies before modern medicine?

Specialties Ob/Gyn

Published

Looking over ob-gyn notes and wondering, before women could have ultrasounds and d&c's, what happened to molar pregnancies? Without removal, would they ever spontaneously abort? Would they continue to grow until becoming invasive (into the uterine wall)?

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

They would probably develop into uterine cancer.

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Specializes in Psychiatric RN & Retired Psychiatric CNA.

It would likely develop into choriocarcinoma and/or cause a fatal hemorrhage because there's no placenta to receive the maternal blood.

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Specializes in OB.

In a nutshell, women died.

(I said this same statement the other day at work with a lovely but slightly ridiculous client who has decided to refuse Rhogam and asked me what women did before Rhogam existed. I probably could have phrased it better, but...sigh)

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Specializes in ICU/community health/school nursing.
In a nutshell, women died.

(I said this same statement the other day at work with a lovely but slightly ridiculous client who has decided to refuse Rhogam and asked me what women did before Rhogam existed. I probably could have phrased it better, but...sigh)

Yup. And it was probably painful. Do I want to know why someone declined Rhogam?

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Specializes in OB.
Yup. And it was probably painful. Do I want to know why someone declined Rhogam?

In her case she doesn't plan to have any more kids (she's over 40 and thinking "one and done"), so Rh sensitization would be a non-issue. She was also pretty sure (but not positive) that her husband is also Rh neg. She also claimed to have read about some ingredient in the Rhogam being harmful in some way...basically she was our typical very "crunchy" client who is generally harmless but occasionally makes a decision like this that makes me cringe (and I say this as a somewhat "crunchy" person myself). We all know surprise babies happen, and while I do have a healthy level of skepticism for a lot of aspects of Western medicine, Rhogam is definitely not one of the things I'm skeptical of.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Libra, I suspect you and I are very similar. I was going to post my suppositions as to why she declined, but wanted to wait to see what you wrote. I could have guessed it, word for word. As another fairly "crunchy" mother, myself. I look back at some of the choices I made as a new/pregnant mom and think "what was I thinking?"

But as I suspect you feel the same, I know in many ways it helps me to relate to some of the more radical parents and their choices and thought processes.

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Specializes in OB.
Libra, I suspect you and I are very similar. I was going to post my suppositions as to why she declined, but wanted to wait to see what you wrote. I could have guessed it, word for word. As another fairly "crunchy" mother, myself. I look back at some of the choices I made as a new/pregnant mom and think "what was I thinking?"

But as I suspect you feel the same, I know in many ways it helps me to relate to some of the more radical parents and their choices and thought processes.

*Virtual fist-bump*

I only had my first child 18 months ago, and had already been a nurse and a midwife for a little while. I'm grateful for the respect for evidence-based practice that nursing has given me, but I also rely on my mom gut/intuition to occasionally make choices that are possibly not supported by evidence but that I feel are best for my family. It's the really radical parents that I currently take care of frequently that I have a hard time NOT being super blunt with. My previous job was such a different population of women, mostly from third-world countries, who were so grateful for anything to do with modern medicine (vaccines, birth in a clean, equipped hospital, etc.) that it's disorienting sometimes to deal with the other end of the spectrum.

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In the case of Rh incompatibility, in a nutshell, the baby died. Mom usually wouldn't experience any physical problem at all. It's the antibodies that her Rh negative body develop during her first Rh positive pregnancy that become a problem for any subsequent Rh positive fetuses.

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Specializes in Women's health & post-partum.

Years ago I remember a colleague and I read an article about a (15th or 16th century, I think) woman who had been delivered of a multiple pregnancy of "over 100 infants ". We decided that had to have been a molar pregnancy.

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Specializes in Reproductive & Public Health.
In her case she doesn't plan to have any more kids (she's over 40 and thinking "one and done"), so Rh sensitization would be a non-issue. She was also pretty sure (but not positive) that her husband is also Rh neg. She also claimed to have read about some ingredient in the Rhogam being harmful in some way...basically she was our typical very "crunchy" client who is generally harmless but occasionally makes a decision like this that makes me cringe (and I say this as a somewhat "crunchy" person myself). We all know surprise babies happen, and while I do have a healthy level of skepticism for a lot of aspects of Western medicine, Rhogam is definitely not one of the things I'm skeptical of.

I had a patient refuse rhogam during and after her pregnancy, because for her the theoretical risk of some yet-undiscovered blood borne pathogen was greater than the risk of sensitization. She swore up and down she would never have another baby. I think back on that patient a lot. I was so young then, I bet she would have accepted if I had counseled her more effectively :(

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Specializes in Reproductive & Public Health.
Libra, I suspect you and I are very similar. I was going to post my suppositions as to why she declined, but wanted to wait to see what you wrote. I could have guessed it, word for word. As another fairly "crunchy" mother, myself. I look back at some of the choices I made as a new/pregnant mom and think "what was I thinking?"

But as I suspect you feel the same, I know in many ways it helps me to relate to some of the more radical parents and their choices and thought processes.

Yep. I started my career as a woo-filled homebirth midwife. I endangered my patients by discouraging vaccines, promoting homeopathy and rolling my eyes about the dangers of GBS. Natural was better. Birth is just a normal process. Doctors and big Pharma make money by keeping you sick. I rejected science because of my ideology.

I am very ashamed of this and it is why I work so hard to promote science-based medicine. It's why I advocate for a universal standard for all midwives. Direct entry midwives are not trained to the standards of the ICM and its unacceptable. Our patients deserve better. I could have killed or seriously hurt someone with my recommendations, and this stuff goes on EVERY DAY.

And whats worse, I learned that pseudoscience in my CPM program! A whole class on homeopathy, yet none on hormonal birth control. We learned about lotus births and placentophagy, but not about how to recognize and treat PPD. I just can't even.

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