Kehamilan merupakan suatu anugerah paling membahagiakan bagi sebagian besar wanita. Tapi bagaimana jika janin yang dikandung tidak berkembang sebagaimana yang diharapkan, misalnya jika kehamilan yang terjadi ternyata hanyalah hamil anggur saja. Hamil anggur bagi seorang wanita bagaikan sebuah mimpi buruk, harapan yang hilang begitu saja. Lalu, sebenarnya apa sih yang dimaksud dengan hamil anggur itu? Kejadian hamil anggur terjadi pada 1 dalam 1500 kehamilan di Amerika Serikat dan Eropa. Ternyata jumlah kejadian tersebut jauh lebih sering terjadi di bagian dunia lain seperti di Asia (misalnya di Taiwan, insidensinya sekitar 1 dari 125 kehamilan). Ini menunjukkan adanya peranan ras dalam kasus hamil anggur. Hamil anggur atau dalam dunia kedokteran dikenal dengan nama mola hydatidosa sesungguhnya merupakan tumor jinak dari vili korion, yang dapat terjadi pada wanita dalam masa reproduksi. Pada pemeriksaan, terlihat gelembung-gelembung yang berasal dari vili yang mengalami perubahan patologis dan berisi cairan jernih. Umumnya tidak ada janin pada peristiwa hamil anggur, namun terkadang pada kasus mola partialis/sebagian terdapat janin atau paling tidak kantong amnion. Akan tetapi, tetap saja janin biasanya tidak dapat dipertahankan dan akan mengalami keguguran. Pada kasus mola hydatidosa, indung telur wanita dapat mengandung kista lutein (bisa salah satu atau pada kedua indung telur) yang akan hilang dengan sendirinya setelah mola dikeluarkan. Selain itu, dari pemeriksaan kromosom pada gelembung-gelembung tersebut, didapatkan kasus poliploidi dan hampir pada semua kasus mola ternyata susunan seks kromatinnya adalah wanita (46, XX). Setelah diteliti lebih lanjut, ternyata usia ibu saat hamil memiliki peranan penting sebagai faktor pertahanan terhadap kejadian hamil anggur. Diketahui tingginya frekuensi kejadian hamil anggur terjadi diantara kehamilan yang berada dalam periode mendekati akhir masa reproduksi. Wanita dengan umur lebih dari 45 tahun relatif mempunyai kemungkinan mengalami hamil anggur sebanyak 10x lebih besar dibandingkan mereka yang masih berusia 20-40 tahun. Penyebab sesungguhnya dari hamil anggur belum diketahui secara pasti. Namun ada beberapa faktor yang dapat mempengaruhi persentase kemungkinan seorang wanita untuk mengalami hamil anggur, antara lain: sering keguguran, status gizi kurang baik, kekurangan vitamin (misalnya vitamin A atau asam folat), gangguan peredaran darah di rahim. Gejala-gejala hamil anggur (pada pasien yang amenorrhae/terlambat haid):
  1. Pendarahan terus-menerus pada minggu ke 12 kehamilan (bervariasi, bisa hanya bercak-bercak sampai pendarahan dalam jumlah banyak, seringkali berwarna kecoklatan). Biasanya menyebabkan anemia dan kekurangan zat besi.
  2. Pembesaran perut (pertumbuhan ukuran rahim) tidak sesuai dengan usia kehamilan atau lebih cepat dari biasanya (misalnya hamil 1 bulan terlihat seperti hamil 3 bulan).
  3. Mual-mual dan muntah lebih sering terjadi dan durasinya lebih lama.
  4. Timbul tekanan darah tinggi yang terkait kehamilan (jika terjadi sebelum minggu ke 24 mengarah pada hamil anggur).
  5. Tidak ada tanda-tanda adanya janin (tidak ada bunyi detak jantung anak, rangka janin tidak nampak pada hasil rontgen).
  6. Kadar hormon korionik gonadotropin (HCG) tinggi dalam darah dan air kencing ibu.
Walaupun banyak gejala yang bisa kita gunakan untuk memperkirakan hamil anggur, diagnosa pasti baru bisa kita dapatkan setelah melihat lahirnya gelembung-gelembung mola. Selain dengan melihat gejala-gejala yang ada, dapat juga dilakukan pemeriksaan untuk menegakkan diagnosa, antara lain:
  • Rontgen: untuk melihat rangka bayi, tapi jika tidak terlihat belum tentu terjadi hamil anggur.
  • Reaksi biologis dengan Galli Mainini: pengukuran kadar gonadotropin secara kuantitatif.
  • Percobaan sonde: pada hamil anggur, sonde mudah masuk, sedangkan pada kehamilan biasa, ada tahanan dari janin.
  • Suntikan zat kontras ke dalam uterus: memperlihatkan gambaran sarang tawon.
  • USG: memperlihatkan gambaran badai salju.
Hamil anggur atau mola hydatidosa merupakan salah satu penyebab kematian pada ibu hamil. Kematian yang terjadi umumnya disebabkan oleh :
  1. perdarahan
  2. perforasi/terjadinya lubang akibat gelembung menembus dinding rahim
  3. infeksi, sepsis
  4. kanker korion (choriocarcinoma): terjadi pada mola hydatidosa lengkap yang merupakan penyebab utama dari choriocarcinoma
Karena mengandung bahaya kematian, maka hamil anggur harus segera ditangani. Penanganan terhadap hamil anggur meliputi 2 tahap, yaitu pengguguran sesegera mungkin, dan melakukan pengawasan terhadap kemungkinan timbulnya gejala-gejala kanker korion (choriocarcinoma). Tindakan pengguguran harus dilakukan segera supaya kehamilan yang tidak normal itu tidak bertambah besar dan merusak kondisi ibu. Pada wanita usia subur yang masih menginginkan anak dilakukan dengan cara kuret, sedangkan pada wanita usia lanjut atau yang sudah tidak menginginkan anak dapat dilakukan pengangkatan rahim (histerektomi).

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Pengguguran dan kuret harus disertai dengan transfusi darah karena ada kemungkinan besar terjadi perdarahan yang banyak. Kemudian kira-kira 10-14 hari setelah kuret pertama, dilakukan kuret kedua yang bertujuan untuk menghasilkan rahim yang benar-benar bersih. Wanita yang mengalami mola hydatidosa boleh hamil lagi, tetapi harus menunggu sampai pemeriksaan pengawasan selesai dilakukan. Bagi wanita yang belum mempunyai anak dianjurkan menunda kehamilan selama 1 tahun, sedangkan bagi wanita yang sudah mempunyai anak dianjurkan untuk tidak hamil dulu selama 2 tahun. Sumber : Ilmu Kebidanan Patologi. Bagian Ilmu Kebidanan dan Kandungan Fakultas Kedokteran Universitas Padjadjaran Bandung Williams Obstetrics, 16th Edition www.hanyawanita.com http://www.freewebtown.com/cakmoki/ebook/mola_hidatidosa.pdf