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Excerpt
The incidence of molar pregnancy was 2.48 per 1000 deliveries and 1.84 per 1000 pregnancies. The age of the patients ranged from 14 to 45 years with a mean age of 25.29 years. Hydatidiform mole was diagnosed in the first pregnancies in 60 percent of the patients (186/310).
Seventeen patients (5.5 percent) had a history of previous hydatidiform mole and eight had at least two previous molar pregnancies. The most frequent presenting symptom was vaginal bleeding (71 percent). The uterine size was larger, normal, or smaller when compared with the predicted measurements according to the last menstrual period in 44 percent, 41 percent, and 15 percent of cases, respectively. Although theca-lutein cysts were found in 17.1 percent of patients (53/310), only one patient underwent emergency surgery due to torsion of the cyst.
Histopathological evaluation revealed complete and partial hydatidiform mole in 96.5 percent (299/310) and 3.5 percent (11/310) of the patients, respectively. Suction D & C was performed as the initial treatment protocol in all cases. Uterine perforation requiring surgical repair occurred during evacuation in two patients (0.6 percent) and methotrexate was administered in these cases.
During follow-up, 14.5 percent of patients (45/310) were diagnosed as persistent cases based on serum beta-hCG concentrations. Complete remission was achieved with the administration of two to eight courses of single-agent chemotherapy in 43 cases. Combined chemotherapy (EMA-CO) was given (3-7 courses) to two patients who were resistant to single-agent therapy. The treatment protocol was carried out according to Eastern Cooperative Oncology Group toxicity criteria. No serious complications related to chemotherapy developed in any of the patients. Hysterectomy was performed in 14 patients who were over 40 years of age.
Patients with spontaneous remission and persistent trophoblastic disease were compared with regard to age, histologic type, previous history, initial uterine size, gravidity, presence of theca-lutein cysts, and initial beta-hCG concentrations, and none of these criteria were found to be prognostic for the occurrence of persistent disease.
(This report of the large experience with hydatidiform mole from Ankara, Turkey reflects some of the changes in the presentation of this disease that have been reported in recent years. Only 71 percent of these patients had a chief complaint of uterine bleeding, which is in contrast to 91 percent in a series from 1965 to 1975 at the New England Trophoblastic Disease Center (Soto-Wright et al., Obstet Gynecol 1995;86: 775). Other complications such as preeclampsia, hyperemesis, and hyperthyroidism are also rare today in comparison to 20 years ago. The median estimated gestational age at the time of evacuation is now about 12 weeks compared with 16 weeks in the period 1965 to 1975. This is primarily because of early diagnosis by ultrasound, which is now commonly available in most obstetricians' offices. The use of transvaginal ultrasound does not seem to offer any advantage over conventional abdominal ultrasound, probably because the enlarged uterus with a characteristic vesicular pattern is easily diagnosed with either technique. In a series of 60 patients, Teng et al. found no difference in the accuracy of the diagnosis or outcome of the molar pregnancy related to the mode of scanning (J Reprod Med 1995;40:427).
In the paper abstracted above, 15 percent of the 299 patients with complete hydatidiform mole developed persistent disease requiring chemotherapy. This is somewhat better than the 23 percent reported by the New England Trophoblastic Disease Center and about the same (17 percent) as reported by Fukunaga et al. from Tokyo (Cytometry 1995;22:135).
