MOLAR PREGNANCY: FOLLOW-UP BEYOND ONE UNDETECTABLE SERUM ²-hCG, IS IT NECESSARY? Nirmala CK,...
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Gestational trophoblastic disease is a common gynaecological problem in Asia with incidence of 1 to 3 in 1000 pregnancies 2-7.
In Malaysia, the estimated incidence of molar pregnancy was 2.8 in 1000 deliveries in 19981.
GTD is considered highly curable, but accurate initial management is essential.
GTD produces serum -hCG level (human chorionic gonadotropin), which can be measured in either urine or serum and will be extremely high in molar pregnancy.
After molar evacuation, patients should be followed with serum -hCG level monitoring and are considered to have achieved remission when serum -hCG level decline to undetectable level within six months.
In view of possible theoretical risk of relapse or developing persistent gestational trophoblastic disease (pGTD), the patients are recommended for continued follow-up with serum -hCG level for a period of two years.
Women often defaulted follow-up and do not complete the recommended long protocol. The long protocol has caused significant practical and emotional complications to the woman and her family. INTRODUCTIONOBJECTIVESMETHODOLOGY AND RESULTSRESULTSDISCUSSIONSivanesaratnam V. The management of gestational trophoblastic disease in developing countries such as Malaysia. International Journal of Gynaecology & Obstetrics 1998. 60(1): 105-109.Ross SB, Donald PG. Current management of gestational trophoblastic diseases. Gynecologic Oncology. 2009; 112: 654 662.Mungan T, Kuscu E, Dabakoglu T et al. Hydatidiform mole: clinical analysis of 310 patients. Int J Gynecol Obstet. 1996; 52: 233-236.Dalya A, Tommaso B, George C et al. Recognising gestational trophoblastic disease. Best Practice & Research Clinical Obstetrics and Gynaecology. 2009; 23: 565-573.Soper JT, Mutch DG, Schink JC. American College of Obstetrician and Gynecologists. Diagnosis and treatment of gestational trophoblastic disease: ACOG Practice Bulletin No.53. Gynecol Oncol. 2004; 93(3): 575-585.Altieri A, Franceshi S, Ferlay et al. Epidemiology and aetiology of gestational trophoblastic diseases. Lancet Oncol. 2003; 4(11): 670-678.Audu BM, Takai IU, Chama CM et al. Hydatidiform mole as seen in a university teaching hospital: a 10-year review. J Obstet gynaecol. 2009; 29(4): 322-325.Hou JL, Wan XR, Xiang Y et al. Changes of clinical features in hydatidiform mole: analysis of 113 cases. J Reprod Med. 2008; 53(8): 629-633.REFERENCES
MOLAR PREGNANCY: FOLLOW-UP BEYOND ONE UNDETECTABLE SERUM -hCG, IS IT NECESSARY?Nirmala CK, Harry SR, Nor Azlin MI, Lim PS, Shafiee MN, Nur Azurah AG, Shamsul AS, Omar MH, Hatta MD Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur. Malaysia.
Presenting clinical featuresn=102 (%) Vaginal bleeding97 (95.1) Hyperemesis4 (3.9) Symptom of thyrotoxicosis1 (1) Clinical diagnosis miscarriage31 (30.4) Hypertension4 (3.9) Sign of thyrotoxicosis1 (1.0) Uterus larger than dates18 (17.6) Ultrasound snow-storm feature48 (47.1)Presenting initial diagnosis Molar pregnancy70 (68.6) Miscarriage32 (31.4)
Histology diagnosisn=102 (%)Complete hydatidiform mole 47 (46.1)Partial hydatidiform mole57 (53.9)
Mean pre-evacuation serum -hCG level (mIU/ml) p=0.47Complete hydatidiform mole491328.18806110.13Partial hydatidiform mole210707.10373543.58Mean post-evacuation serum -hCG level (mIU/ml) p=0.45Complete hydatidiform mole58380.10132812.97Partial hydatidiform mole27058.6678113.26