Guidelines following hydatidiform mole: a reappraisal.
OBJECTIVE
The aim of this study was to determine how often patients with complete hydatidiform mole (CHM) who spontaneously achieve normal human chorionic gonadotrophin (hCG) levels subsequently develop persistent or recurrent gestational trophoblast disease.


METHODS
Four hundred and fourteen cases of CHM registered at the Hydatidiform Mole Registry of Victoria were reviewed retrospectively after molar evacuation. Maternal age, gestational age, gravidity and parity were determined for each patient, as well as the need for chemotherapy.


RESULTS
Among the 414 patients, 55 (13.3%) required chemotherapy for persistent trophoblastic disease. None of the patients whose hCG levels spontaneously fell to normal subsequently developed persistent molar disease.


CONCLUSIONS
Weekly hCG measurements are recommended for all patients until normal levels are achieved. For patients who attain normal hCG levels within 2 months after evacuation, it seems safe to discontinue monitoring once normal levels are achieved. Patients who fail to achieve normal hCG levels by 2 months after evacuation should be monitored with monthly hCG measurements for 1 year after normalisation to assure sustained remission.
Kerkmeijer
Linda
L
Department of Obstetrics and Gynaecology, Radboud University, Nijmigen, The Netherlands.
Wielsma
Sabien
S
Wiesma
Sabien
S
Bekkers
Ruud
R
Pyman
Jan
J
Tan
Jeffrey
J
Quinn
Michael
M
D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood; D017024:Chemotherapy, Adjuvant; D006063:Chorionic Gonadotropin / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006828:Hydatidiform Mole / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D007044:Hysterectomy / Q000379:methods; D008423:Maternal Age; D008991:Monitoring, Physiologic / Q000592:standards; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis*; D010298:Parity; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000628:therapy; D011256:Pregnancy Outcome; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery
D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin