What is the optimal duration of human chorionic gonadotrophin surveillance following evacuation of a molar pregnancy? A retrospective analysis on over 20,000 consecutive patients

Abstract

Our results show that pGTN can occur after hCG normalisation following PHM but the risk is extremely low. Women with CHM have a comparatively higher risk of pGTN after hCG normalisation. Those with CHM where hCG normalises within 56days have a lower risk of pGTN. We have revised the current UK hCG surveillance protocol for PHM to a single additional confirmatory normal urine hCG measurement one month after first normalisation. The protocol for CHM remains unchanged.

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

“…Risk of recurrence is low (,2%) after a single molar pregnancy but increases significantly for women who experience one or more recurrences. 2,3,6,12,13,20 Once normalized, recurrent elevation of hCG has been reported in ,1% of patients. 20,21 The occurrence of GTN following hCG normalization is rare after the recommended 6 months of postnormalization hCG monitoring.…”

“…2,3,6,12,13,20 Once normalized, recurrent elevation of hCG has been reported in ,1% of patients. 20,21 The occurrence of GTN following hCG normalization is rare after the recommended 6 months of postnormalization hCG monitoring. 22 A recent study showed that patients with complete HM who normalized beyond 56 days after uterine evacuation had a 3.8-fold higher risk of developing postmolar GTN.…”

“…22 A recent study showed that patients with complete HM who normalized beyond 56 days after uterine evacuation had a 3.8-fold higher risk of developing postmolar GTN. 20 The NCCN Panel recommends hCG assay monitoring every 1 to 2 weeks until levels have normalized, defined in the guidelines as 3 consecutive normal assays. After initial normalization, hCG should be measured twice in 3-month intervals to ensure levels remain normal.…”

Twin pregnancy with a partial hydatidiform mole and a coexistent live fetus. Diagnostic and therapeutic dilemmas. A case report and the review of literature

“…Differentiating of a complete mole from a partial mole is particularly important for choosing sufficient length of follow-up. With partial moles the risk of subsequent GTN is several-fold lower [17]. When a partial mole in a singleton pregnancy is evacuated, the patient needs to remain under observation for 4 weeks after the normalization of hCG.…”

Hepatic toxicity following actinomycin D chemotherapy in treatment of familial gestational trophoblastic neoplasia

“…Due to lack of specific histological features, GTN is mainly diagnosed by beta-hCG surveillance. [ 3 , 4 ] Although most women can be cured by chemotherapy, many interesting issues arise. For example, we still do not fully understand why molar pregnancy happens and cannot predict whether it will recur or be followed by the development of GTN.…”