A 14-Year Retrospective Study of Molar Pregnancy in Maharaj Nakorn Chiang Mai Hospital : High Incidence of Persistent Disease

Abstract

Objective To determine the clinical characteristics and outcomes of patients with histologically diagnosed hydatidiform mole.

Subjects One hundred and sixty nine patients with histologically diagnosed hydatidiform mole between January 1984 to December 1997 Main outcome measures : Clinical characteristics, remission, and the incidence of persistent gestational trophoblastic disease (PGTD).

Results: The incidence is 1.96:1,000 deliveries. The mean maternal age was 27.8 years (range 14-54). Forty two percent of patients were primigravida. The mean gestational age at diagnosis was 14.4 weeks (range 6-28). The average uterine size at surgical evacuation was 17.4 weeks (range 8-32). The most common presenting symptoms was vaginal bleeding. About 90 % of patients were classified as high risk for PGTD. The incidence of PGTD was 53.3 % in patients undergoing suction curettage without chemoprophylaxis. When separately analyzed, PGTD occurred in 59 % and 16.7 % of high-risk and low-risk patients, respectively. The incidence of PGTD remained high at 43.8 % despite receiving chemoprophylaxis during suction evacuation. PGTD also occurred in 12.5 % of patients undergoing hysterectomy with chemoprophylaxis. Loss of follow-up rate was relatively high at 28 %.

Conclusion Due to high incidence of PGTD, regular follow-up with sensitive hCG assays must be emphasized to all patients following termination of molar pregnancy.