Diseases Treated

Gestational Trophoblastic Disease/Molar Pregnancy

What happens after the diagnosis is confirmed?

Once the diagnosis of molar pregnancy is confirmed, the uterine cavity should be emptied promptly. Eighty percent of women with complete molar pregnancy will be cured with no therapy other than removal of the molar tissue. This leads to a gradual drop in the blood level of hCG and a resumption of normal menses. However, in approximately 20 percent of patients with complete molar pregnancy and 5 percent with a partial mole the abnormal placental tissue regrows and further treatment is required in order to prevent serious consequences. When regrowth of abnormal placental tissue develops we say that the patient has developed a gestational trophoblastic tumor.

In an attempt to predict which patients with complete molar pregnancy are more likely to develop complications following evacuation of the uterus, we have divided our patients into two groups - low and high risk. Specialized treatment programs have been developed for both of these groups. All patients with a partial molar pregnancy are in the low risk group. Low risk complete molar pregnancy occurs when the uterus is equal to or smaller than dates, when the hCG level is in the range of a normal pregnancy, when the maternal age is under 40 and over 16, and when there are no other associated factors such as hypertension, hyperthyroidism, blood clotting problems and/or a history of previous molar pregnancy or trophoblastic tumors.

High risk complete molar pregnancy occurs when the uterus is larger than dates, the hCG level is higher than is usually seen in normal pregnancy, the ovaries are enlarged and cystic, the maternal age is over 40 or under 18, and there is hypertension, hyperthyroidism, blood clotting problems and/or a history of previous molar pregnancy or trophoblastic tumor.

The treatment for molar pregnancy utilized at the New England Trophoblastic Disease Center depends on whether you fall into the low or high risk category. In general, all patients with partial molar pregnancy appear to fall into the low risk category.

Low risk patients are treated by surgically removing the tissue from the uterus with a suction machine. In some instances, it may be preferable to remove the molar pregnancy by performing an abdominal hysterectomy. If suction evacuation is carried out the hospitalization will usually last 48 hours. If hysterectomy appears to be the treatment of choice, then hospitalization will usually last about one week. Hysterectomy is performed only in patients who want surgical sterilization.

High risk patients, on the other hand, are treated by a combination of suction evacuation of the uterus (or hysterectomy) and the administration of a course of drug therapy (chemotherapy). Occasionally, when patients have enlarged ovarian cysts, then laparoscopy is also performed to decompress the so-called "theca lutein cysts" which generally occur bilaterally. The treatment of the high-risk patient requires a short hospital stay depending on the type of chemotherapy.