Skip to content

Health & Pregnancy

Font Size

Hydatidiform Mole (HM) Management

    Treatment of HM is within the purview of the obstetrician/gynecologist and will not be discussed separately here. However, following the diagnosis and treatment of HM, patients should be monitored to rule out the possibility of metastatic gestational trophoblastic neoplasia (GTN). In almost all cases, this can be performed with routine monitoring of serum beta human chorionic gonadotropin (beta-hCG) to document its return to normal. An effective form of contraception is important during the follow-up period to avoid the confusion that can occur with a rising beta-hCG as a result of pregnancy.

    Chemotherapy is necessary when there is the following:

    1. A rising beta-hCG titer for 2 weeks (3 titers).
    2. A tissue diagnosis of choriocarcinoma.
    3. A plateau of the beta-hCG for 3 weeks.
    4. Persistence of detectable beta-hCG 6 months after mole evacuation.
    5. Metastatic disease.
    6. An elevation in beta-hCG after a normal value.
    7. Postevacuation hemorrhage not caused by retained tissues.

    Chemotherapy is ultimately required for persistence or neoplastic transformation in about 15% to 20% of patients after evacuation of a complete HM but for fewer than 5% of patients with partial HM. Chemotherapy is the same as for nonmetastatic GTN.

    In women with complete HM, risk of persistence or neoplastic transformation is approximately doubled in the setting of certain characteristics, which include the following:

    • Age older than 35 years or age younger than 20 years.
    • Pre-evacuation serum beta-hCG greater than 100,000 IU/L.
    • Large-for-date uterus.
    • Large uterine molar mass.
    • Large (>6 cm) ovarian cysts.
    • Pre-eclampsia.
    • Hyperthyroidism.
    • Hyperemesis of pregnancy.
    • Trophoblastic embolization.
    • Disseminated intravascular coagulation.

    Studies have shown that a single course of prophylactic dactinomycin or methotrexate can decrease the risk of a postmolar GTN.[1,2,3] However, there is concern that chemoprophylaxis increases tumor resistance to standard therapy in the women who subsequently develop GTN.[1] Therefore, this practice is generally limited to countries in which a large number of women do not return for follow-up.

    Current Clinical Trials

    Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with hydatidiform mole. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.

      1|2

      Pregnancy Week-By-Week Newsletter

      Delivered right to your inbox, get pictures and facts on
      what to expect each week of your pregnancy.

      Today on WebMD

      hand circling date on calendar
      Track your most fertile days.
      woman looking at ultrasound
      Week-by-week pregnancy guide.
       
      Pretty pregnant woman timing contaction pains
      The signs to watch out for.
      pregnant woman in hospital
      Are there ways to do it naturally?
       
      slideshow fetal development
      Slideshow
      pregnancy first trimester warning signs
      Article
       
      What Causes Bipolar
      Video
      Woman trying on dress in store
      Slideshow
       
      pregnant woman
      Article
      Close up on eyes of baby breastfeeding
      Video
       
      healthtool pregnancy calendar
      Tool
      eddleman prepare your body pregnancy
      Video