Low Risk of Relapse After Achieving Undetectable hCG Levels in Women With Complete Molar Pregnancy
- 1 September 2004
- journal article
- research article
- Published by Wolters Kluwer Health in Obstetrics & Gynecology
- Vol. 104 (3), 551-554
- https://doi.org/10.1097/01.aog.0000136099.21216.45
Abstract
OBJECTIVE: Complete hydatidiform molar pregnancies occur in approximately 1 of 1,000 conceptions. After uterine evacuation of the trophoblastic tissue, women are followed up with serial serum human chorionic gonadotropin (hCG) measurements. Patients are considered to have attained remission when their hCG level spontaneously declines to an undetectable level and remains there during a 6-month follow-up period. This standard effectively detects all disease recurrence; however, it is resource intensive, delays child bearing, and is subject to significant noncompliance. Our objective was to determine the risk of disease recurrence after hCG spontaneously declines to undetectable levels. METHODS: We used a database from the New England Trophoblastic Disease Center to analyze hCG levels in patients with complete molar pregnancies. RESULTS: Among 1,029 women with complete molar pregnancy and complete data, 15% developed persistent gestational trophoblastic neoplasia. The rate of persistent neoplasm among those whose hCG level fell spontaneously to undetectable levels was 0.2% (2/876, 95% confidence interval 0–0.8%). No women developed persistent gestational trophoblastic neoplasia after their hCG level fell to undetectable levels using an assay with a sensitivity of 5 mIU/mL (n = 82, 95% confidence interval 0–4.5%). CONCLUSION: Based on our experience with women with complete hydatidiform molar pregnancies whose hCG values spontaneously fell to undetectable levels after molar evacuation, we conclude that the risk of recurrent neoplasm after hCG levels fall to less than 5 mIU/mL approaches zero. LEVEL OF EVIDENCE: II-2Keywords
This publication has 8 references indexed in Scilit:
- How long should patients be followed after molar pregnancy? Analysis of serum hCG follow-up dataEuropean Journal of Obstetrics & Gynecology and Reproductive Biology, 2004
- Gestational trophoblastic disease in the Asian population of Northern England and North WalesBJOG: An International Journal of Obstetrics and Gynaecology, 2003
- Human chorionic gonadotropin follow-up in patients with molar pregnancy: a time for reevaluationObstetrics & Gynecology, 2003
- Risk of partial and complete hydatidiform molar pregnancy in relation to maternal ageBJOG: An International Journal of Obstetrics and Gynaecology, 2002
- Chorionic TumorsNew England Journal of Medicine, 1996
- A clinical, histopathological and flow cytometric study of 149 complete moles, 146 partial moles and 107 non‐molar hydropic abortionsHistopathology, 1996
- Natural history of hydatidiform mole after primary evacuationAmerican Journal of Obstetrics and Gynecology, 1983
- Molar pregnancy in British Columbia: Estimated incidence and postevacuation regression patterns of the beta subunit of human chorionic gonadotropinAmerican Journal of Obstetrics and Gynecology, 1981