What are the key clinical features and symptoms that suggest a diagnosis of molar pregnancy?

Key clinical features and symptoms that may suggest a diagnosis of molar pregnancy, a form of gestational trophoblastic disease, often overlap with those of a miscarriage ¹,³.

Common presentations include vaginal bleeding [1, (Chawla et al., 2023)]. Patients may also experience excessive nausea and vomiting, referred to as hyperemesis gravidarum [ (Heřman et al., 2025), (Chawla et al., 2023)].

On examination, the uterus may be larger than expected for the gestational age [ (Heřman et al., 2025), (Chawla et al., 2023)]. Laboratory tests typically reveal abnormally high levels of human chorionic gonadotropin (hCG) [ (Heřman et al., 2025), (Chawla et al., 2023)].

Other less common but significant indicators can include the absence of fetal heart sounds [ (Heřman et al., 2025)], the early onset of pre-eclampsia [ (Heřman et al., 2025), (Chawla et al., 2023)], or the passage of 'grape-like' vesicles [ (Heřman et al., 2025), (Chawla et al., 2023)]. Definitive diagnosis relies on histopathological examination [ (Sebire, 2010), (Heřman et al., 2025)].