Ten patients with hydatidiform mole treated by primary hysterectomy were retrospectively compared with 24 patients whose moles were evacuated by suction curettage. All patients were 35 years old or more and were followed up for 1 year following the evacuation. During follow-up, 10% of the hysterectomized patients needed chemotherapy in comparison with 33.4% of the non-hysterectomized patients. This difference was not statistically significant. There was also no statistically significant difference when the serial serum beta-subunit of human chorionic gonadotrophin (beta-hCG) regression rates of the two groups were compared. The study shows that primary hysterectomy does not worsen the prognosis of gestational trophoblastic disease, however, it does not negate the need for careful follow-up.
During a 4-year period, 163 patients conceived after treatment of their infertility due solely to a female factor. They were divided into two groups, 108 patients treated medically (Group 1) and 55 treated surgically (Group 2). At the time of conception, the mean age in Group (1) was 24.9 +/- 5.7 years while in Group (2) it was 31.2 +/- 6.1 years. The difference was statistically significant (p less than 0.01). The duration of infertility prior to pregnancy and the treatment-to-pregnancy interval were both significantly longer in Group (2) (p less than 0.05). The rates of miscarriage, multiple pregnancy, and preterm labor were higher in Group (1), though the differences were statistically not significant. In contrast, the rate of ectopic pregnancy was significantly higher in Group (2) (p less than 0.05), as was the need for elective cesarean section (p less than 0.01). Despite these differences, both groups had nearly the same perinatal outcome.
The outcome in 80 patients who had routine repcat uterine curettage following primary evacuation of hydatidiform mole was compared with that of 76 patients in whom a routine repeat curettage was not performed. The incidence of need for chemotherapy at the end of a 1 year follow up was 16 per cent in the 'curettage' group and I8 per cent in the 'no curettage' group. This difference was not significant. In only 7.5 per cent of patients was trophoblastic tissue obtained during the routine repcat curettage. The histological yield did not predict the course of the disease. Repeat curettage after primary evacuation of molar pregnancy should not be performed as a routine procedure.
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