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. 2021 Apr;61(2):213-216.
doi: 10.1111/ajo.13258. Epub 2020 Oct 8.

Assessment of current follow-up for complete molar pregnancies: A single centre review

Gaithri Mylvaganam  1   2 , Emma Allanson  2 , Ben Allanson  3 , Shannon Philp  2 , Selvan Pather  2 , Rhonda Farrell  2 , Jonathan Carter  2 , Trevor Tejada-Berges  2
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Assessment of current follow-up for complete molar pregnancies: A single centre review

Gaithri Mylvaganam et al. Aust N Z J Obstet Gynaecol. 2021 Apr.

Abstract

Background: Current guidelines recommend that resolution of a complete molar pregnancy (CMP) can only be confirmed once a negative β-human chorionic gonadotropin (β-hCG) has been maintained for six months following uterine surgical evacuation. However, multiple studies have found that the risk of developing gestational trophoblastic neoplasia (GTN) once a negative β-hCG had been obtained is negligible, which suggests that a shorter follow-up may be reasonable.

Aim: To determine the trend in β-hCG following diagnosis of a CMP and the incidence of GTN, in a single unit.

Materials and methods: All patients presenting to the tertiary hospital, Royal Prince Alfred Hospital Early Pregnancy Assessment Service (RPAH EPAS), with a histopathological diagnosis of a CMP between 2010 and 2017 were included. Data collected included age, parity, β-hCG at diagnosis, subsequent β-hCG levels, incidence of GTN and treatment required.

Results: Sixty-seven patients were diagnosed with CMP between January 2010 and July 2017 through RPAH EPAS. The mean age of women diagnosed with a CMP was 33 years. None of the 40 patients who spontaneously achieved a negative β-hCG and completed their six months follow-up had a subsequent rise in β-hCG. The median number of days from surgical evacuation to normalisation of β-hCG was 55.5 days. Sixteen out of 67 patients who had a CMP required further management for persistent GTN. None of these patients achieved a negative β-hCG prior to further management.

Conclusions: Consideration could be made to decreasing the period of β-hCG monitoring for women who achieve a spontaneous negative β-hCG following surgical evacuation of a CMP.

Keywords: complete molar pregnancy; follow-up; gestational trophoblastic disease; gestational trophoblastic neoplasia; treatment.

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References

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