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Human chorionic gonadotropin surveillance in hydatidiform mole: A need for reevaluation

Marie Christine Valerie R. Mendoza, MD; Melissa Lourdes B. De Quiros, MD and Agnes L. Soriano-Estrella, MD, MHPEd, FPOGS, FPSSTD
Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines-Manila

Introduction: Serial beta human chorionic gonadotropin (?hCG) monitoring after molar evacuation is advised for early detection of persistent trophoblastic disease. The aim of this study was to determine the percentage of patients who developed post-molar gestational trophoblastic neoplasia during a 6-month follow up period after normalization of ?hCG titers to that during a 12-month follow up period in order to ascertain the appropriate period of ?hCG surveillance for patients who underwent treatment for molar pregnancy.

Methods: Data was analyzed from the Section of Trophoblastic Diseases at the Philippine General Hospital - Department of Obstetrics and Gynecology to estimate the incidence of persistent trophoblastic disease among 258 women with molar pregnancy from 2000-2011.

Results: Among the 258 registered hydatidiform mole patients, 205 patients (79.5%) attained normal ?hCG titers titer levels after evacuation of molar products. There was no occurrence of postmolar gestational trophoblastic neoplasia among patients who achieved normalization of ?hCG titers after treatment. ?hCG levels did not attain normalization following evacuation in 53 patients (20.5%). Out of the 53 patients, 50 patients (94.3%) were detected to have gestational trophoblastic neoplasia within the first six months post-treatment. Only 3 patients (5.7%) were determined to have disease progression after six months during the one-year follow-up period.

Conclusion: The follow-up period after a molar pregnancy may be reduced for patients whose serum ?hCG levels spontaneously decline to normal levels after evacuation. The results of this study showed that the median time to obtaining normal ?hCG levels is 88 days for those who received chemoprophylaxis and 85 days for those with lower initial ?hCG values (less than 100, 000 mIU/ml).