Evacuation Of Complete Mole Research Articles

A Case of Persistent Gestational Trophoblastic Disease after Complete Hydatidiform Mole

Gestational trophoblastic disease is an abnormal proliferations of trophoblastic tissue during pregnancy. Persistent gestational trophoblastic t umor develops in about 20% after evacuation of complete mole. Following evacuation of hydatidiform mole, the interpretation of serial serum human chorionic gonadotropin (hCG) regression patterns is important in monitoring the course of the disease. Because it is the most reliable and sensitive method for the early detection of gestational trophoblastic disease. We describe an uncommon case of complete hydatidiform mole in a 48-year-old woman, who has presented to us with complaints of bleeding. She experienced after the evacuation of a complete mole and no decreased in hCG levels over four consecutive serum hCG measurements. The patient underwent hysterectomy due to leiomyoma. Finally, pathologic diagnosis was confirmed persistent gestational trophoblastic disease. Key words: Hydatidiform mole; Gestational trophoblastic disease

Prediction of persistent gestational trophobalstic neoplasia: The role of hCG level and ratio in 2 weeks after evacuation of complete mole

ObjectiveThe aim of this study was to determine whether or not the serum human chorionic gonadotropin (hCG) level and ratio during 2weeks after evacuation is predictive of persistent gestational trophoblastic neoplasia (GTN) in patients with complete molar pregnancies. MethodsBetween January 2000 and June 2010, a total of 467 patients with complete molar pregnancies were diagnosed. Seventeen patients, who had prophylactic chemotherapy and in whom insufficient data were available, were excluded. A receiver operating characteristic curve was used to determine the most useful predictive factor for persistent GTN and multivariate logistic regression was used for analyses. ResultsPersistent GTN was diagnosed in 109 of the 450 patients (24.2%) on the basis of the 2000 FIGO criteria. The optimal cut-off point for hCG 1 and 2weeks after evacuation was 6400 mIU/mL (sensitivity, 54.1%; specificity, 65.1%) and 2400 mIU/mL (sensitivity, 64.2%; specificity, 78.3%), respectively. The optimal cut-off point for the ratio of pre-evacuation hCG to hCG 2weeks after evacuation was 30 (sensitivity, 63.3%; specificity, 86.5%). Based on multivariate analysis, this ratio<30 was an independent predictive factor for persistent GTN (odds ratio=6.885; 95% confidence interval, 4.006–11.832; P<0.001). ConclusionsThe decline ratio in hCG level 2weeks after evacuation in patients with complete molar pregnancies is the most reliable predictor of persistent GTN. Our analysis may allow clinicians to stratify risk in patients with complete molar pregnancies and to provide more accurate counseling based on the hCG levels obtained 2weeks after evacuation.