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

• Published in: Australian & New Zealand journal of obstetrics & gynaecology 2021-04, Vol.61 (2), p.213-216
• Main Authors: Mylvaganam, Gaithri, Allanson, Emma, Allanson, Ben, Philp, Shannon, Pather, Selvan, Farrell, Rhonda, Carter, Jonathan, Tejada‐Berges, Trevor
• Format: Article
• Language: English
• Subjects: complete molar pregnancy; follow‐up; gestational trophoblastic disease; gestational trophoblastic neoplasia; treatment
• ISSN: 0004-8666; 1479-828X
• DOI: 10.1111/ajo.13258

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.