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Late spontaneous resolution of persistent molar pregnancy
Author(s) -
Taylor F,
Short D,
Harvey R,
Winter MC,
Tidy J,
Hancock BW,
Savage PM,
Sarwar N,
Seckl MJ,
Coleman RE
Publication year - 2016
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.13867
Subject(s) - molar pregnancy , medicine , pregnancy , retrospective cohort study , chemotherapy , human chorionic gonadotropin , obstetrics , falling in love , gynecology , gestation , surgery , hormone , art , genetics , literature , biology
Objective To determine the outcome of women with persistently raised but falling human chorionic gonadotrophin ( hCG ) levels 6 months after surgical evacuation of a molar pregnancy. Design An 11‐year retrospective review. Setting The United Kingdom supra‐regional trophoblastic disease treatment centres at Weston Park Hospital (Sheffield) and Charing Cross Hospital (London). Population Women with raised but falling serum human chorionic gonadotrophin ( hCG ) levels 6 months after evacuation of a molar pregnancy. Methods Retrospective case note review of eligible women identified by the electronic databases held at each supra‐regional centre. Main outcome measures The proportion of women that attain normal hCG levels spontaneously without chemotherapy. In addition, rates of gestational trophoblastic neoplasia ( GTN ), drug resistance, disease relapse and overall survival are reported. Results Thirty‐five women with molar pregnancy and raised but falling serum hCG levels continued surveillance 6 months after evacuation. Levels of hCG in 30 of the patients (86%) fell to normal levels spontaneously. One woman defaulted follow up prior to hCG normalisation (3%) and the remaining four women (11%) were treated with chemotherapy due to a plateau or rise in serum hCG levels indicating GTN . All treated women were successfully salvaged by either first ( n = 1) or second line ( n = 2) chemotherapy or found to have persistently raised low level hCG of uncertain clinical relevance ( n = 1). No women developed relapsed disease and overall survival was 100%. Conclusions Women with a molar pregnancy and a raised but falling hCG level beyond 6 months from uterine evacuation can be safely observed with regular hCG monitoring and can usually avoid potentially toxic chemotherapy. Tweetable abstract Women with treated molar pregnancy may avoid chemotherapy if 6‐month hCG levels are raised but falling.