Hydatidiform Mole Treatment & Management

Updated: Nov 15, 2016
  • Author: Lisa E Moore, MD, FACOG; Chief Editor: Warner K Huh, MD  more...
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Treatment

Medical Care

Stabilize the patient.

Transfuse for anemia, and correct any coagulopathy.

Treat hypertension. Watch for and be prepared to treat thyroid storm, a rare complication.

Administer Rh immune globulin to nonsensitized RhD-negative women because of the possibility of a partial mole with fetal erythrocytes that express the RhD antigen. (RhD is not expressed in human trophoblast cells.) [41]

Consultation

A gynecologic oncologist should be consulted if the patient is believed to be at risk for or has developed malignant disease (ie, gestational trophoblastic neoplasia).

Diet and activity

No special diet is required, and patients may resume activity as tolerated.

Pelvic rest is recommended for 2-4 weeks after evacuation of the uterus, and the patient is instructed not to become pregnant for 6 months. Effective contraception is recommended during this period. [42]

Monitor serial beta-hCG levels to identify the rare patient who develops malignant disease. If a pregnancy does occur, the elevation in beta-hCG would be confused with development of malignant disease.

 

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Surgical Care

Evacuation of the uterus by dilation and curettage is always necessary.

Prostaglandin or oxytocin induction is not recommended because of the increased risk of bleeding and malignant sequelae.

Intravenous oxytocin should be started after dilation of the cervix at the initiation of suctioning and continued postoperatively to reduce the likelihood of hemorrhage. Consideration of using other uterotonic formulations (eg, Methergine, Hemabate) is also warranted.

Respiratory distress can occur at the time of surgery. This may be due to trophoblastic embolization, high-output congestive heart failure caused by anemia, or iatrogenic fluid overload. Distress should be aggressively treated with assisted ventilation and monitoring, as required. [26]

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Long-Term Monitoring

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. [43]
  • Once levels have reached the reference range for 3-4 weeks, check them monthly for 6 months. [44, 45, 46]
  • 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. [47]  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. No cases of persistent disease had absence of hTERT; however, some cases in which hTERT was expressed regressed spontaneously. [48]

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