What is included in long-term monitoring of patients with hydatidiform mole?

Updated: Feb 16, 2018
  • Author: Lisa E Moore, MD, FACOG; Chief Editor: Warner K Huh, MD  more...
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Answer

Serial quantitative serum beta-hCG levels should be determined. Note the following:

  • Serum hCG levels are obtained weekly until the levels are within reference range for 3-4 weeks.

  • Levels should consistently drop and should never increase. Normal levels are usually reached within 8-12 weeks after evacuation of the hydatidiform mole. As long as the hCG levels are falling intervention is not needed. [44]

  • Once levels have reached the reference range for 3-4 weeks, check them monthly for 6 months. [45, 46, 47]

  • If the serum hCG levels plateau or rise, the patient is considered to have malignant disease (ie, gestational trophoblastic neoplasia) and metastatic disease needs to be excluded.

Effective contraception is recommended during the period of follow-up. To avoid uterine perforation and bleeding, if an intrauterine contraceptive device (IUD) is selected, insertion should await involution of the uterus and normalization of serum hCG levels.

After a hydatidiform mole, the risk of developing a second mole is 1.2-1.4%. The risk increases to 20% after 2 moles. [48]  Evaluate all future pregnancies early with ultrasonography.

Human telomerase reverse transcriptase (hTERT) expression in the uterine contents of cases of complete mole has been suggested as a marker for persistent disease. The negative predictive value appears most significant. Absence of hTERT expression was associated with a bening course (e.g.., nromalization of serum hCG). All cases of persistent disease expressed hTERT; however, some cases in which hTERT was expressed regressed spontaneously. [49]


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