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Persistence of gestational trophoblastic disease for longer than 1 year following evacuation of hydatidiform mole.

Elmer, David B. MD; Granai, Cornelius O. MD; Ball, Harrison G. MD; Curry, Stephen L. MD
Obstetrics & Gynecology:
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Abstract

Background: A spontaneous fall in the radioimmunossay for the beta subunit of hCG to less than 2 mIU/mL documents regression of hydatidiform mole following evacuation of a molar pregnancy. Continued negative hCG levels for the year after evacuation indicates the absence of risk for persistent gestational trophoblastic disease. This report describes an unusual case of recurrent nonmetastatic gestational trophoblastic disease 16 months after initial evacuation.

Case: A 29-year-old woma presented at 19 weeks' gestation with severe preeclampsia and vaginal bleeding. Pelvic ultrasonography demonstrated a molar pregnancy. Pathology following uterine evacuation confirmed a hydatidiform mole. Serial hCG levels fell progressively to less than 2 mIU/mL over the following 25 weeks. She remained compliant with oral contraceptive pills despite having no sexual activity. Sixteen months after uterine evacuation, recurrence of gestational trophoblastic disease was documented by a rising [beta]-hCG, negative pelvic ultrasound, normal liver function tests, and normal computed tomography of the head. Endometrial curettage showed no chorionic villi or molar tissue. She was treated with five courses of actinomycin D and has remained disease-free for the following 5 years.

Conclusion: This late recurrence of gestational trophoblastic disease suggests that those with a molar pregnancy may benefit from surveillance beyond 1 year after uterine evacuation. (Obstet Gynecol 1993;81:888-90)

(C) 1993 The American College of Obstetricians and Gynecologists