Document Detail


Low risk of relapse after achieving undetectable HCG levels in women with complete molar pregnancy.
MedLine Citation:
PMID:  15339768     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Complete hydatidiform molar pregnancies occur in approximately 1 of 1,000 conceptions. After uterine evacuation of the trophoblastic tissue, women are followed up with serial serum human chorionic gonadotropin (hCG) measurements. Patients are considered to have attained remission when their hCG level spontaneously declines to an undetectable level and remains there during a 6-month follow-up period. This standard effectively detects all disease recurrence; however, it is resource intensive, delays child bearing, and is subject to significant noncompliance. Our objective was to determine the risk of disease recurrence after hCG spontaneously declines to undetectable levels. METHODS: We used a database from the New England Trophoblastic Disease Center to analyze hCG levels in patients with complete molar pregnancies. RESULTS: Among 1,029 women with complete molar pregnancy and complete data, 15% developed persistent gestational trophoblastic neoplasia. The rate of persistent neoplasm among those whose hCG level fell spontaneously to undetectable levels was 0.2% (2/876, 95% confidence interval 0-0.8%). No women developed persistent gestational trophoblastic neoplasia after their hCG level fell to undetectable levels using an assay with a sensitivity of 5 mIU/mL (n = 82, 95% confidence interval 0-4.5%). CONCLUSION: Based on our experience with women with complete hydatidiform molar pregnancies whose hCG values spontaneously fell to undetectable levels after molar evacuation, we conclude that the risk of recurrent neoplasm after hCG levels fall to less than 5 mIU/mL approaches zero.
Authors:
Adam J Wolfberg; Colleen Feltmate; Donald P Goldstein; Ross S Berkowitz; Ellice Lieberman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  104     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-09-01     Completed Date:  2004-12-02     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  551-4     Citation Subset:  AIM; IM    
Affiliation:
Division of Gynecologic Oncology, New England Trophoblastic Disease Center, Donald P. Goldstein M.D. Trophoblastic Tumor Registry, Harvard Medical School, Boston, Massachusetts, USA. awolfberg@partners.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Chorionic Gonadotropin / blood*
Female
Follow-Up Studies
Humans
Hydatidiform Mole / blood*
Neoplasm Recurrence, Local / epidemiology*
Pregnancy
Risk Assessment
Risk Factors
Uterine Neoplasms / blood*
Chemical
Reg. No./Substance:
0/Chorionic Gonadotropin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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