MOLAR PREGNANCY: FOLLOW-UP BEYOND ONE UNDETECTABLE SERUM β-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.

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 β-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 β-hCG level monitoring and are considered to have achieved remission when serum β-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 β-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.

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 β-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 β-hCG level monitoring and are considered to have achieved remission when serum β-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 β-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.

INTRODUCTION

OBJECTIVES

METHODOLOGY AND RESULTS

Presenting clinical features n=102 (%)

Vaginal bleeding 97 (95.1) Hyperemesis 4 (3.9) Symptom of thyrotoxicosis 1 (1) Clinical diagnosis miscarriage 31 (30.4) Hypertension 4 (3.9) Sign of thyrotoxicosis 1 (1.0) Uterus larger than dates 18 (17.6) Ultrasound ‘snow-storm’ feature 48 (47.1)Presenting initial diagnosis Molar pregnancy 70 (68.6) Miscarriage 32 (31.4)

RESULTSHistology diagnosis n=102 (%)Complete hydatidiform mole 47 (46.1)Partial hydatidiform mole 57 (53.9)Mean pre-evacuation serum β-hCG level (mIU/ml) p=0.47

Complete hydatidiform mole 491328.18±806110.13

Partial hydatidiform mole 210707.10±373543.58

Mean post-evacuation serum β-hCG level (mIU/ml) p=0.45

Complete hydatidiform mole 58380.10±132812.97

Partial hydatidiform mole 27058.66±78113.26

DISCUSSION

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REFERENCES