HYDATIDIFORM MOLE FOLLOW-UP

The following notes have been prompted by enquiries we have received relating to these patients. hCG follow-up will range from 6 months to 2 years after evacuation of hydatidiform mole. The patient is contacted directly to send in her samples and is also sent
information about molar pregnancy, contraception and future pregnancy. This information can be found on our Website. We offer a telephone advisory service to clinicians and health professionals as well as to patients registered for follow-up with us.

If the patients hCG levels reach the normal range within 56 days of evacuation, follow-up will be limited to 6 months. Sequelae have not so far been observed in these patients. The majority of patients with partial hydatidiform mole, and patients with lesions suspicious of HM, fall into this short-term follow-up group. It also includes some patients with complete hydatidiform mole.

This laboratory request SERUM samples at 2 weekly intervals post-evacuation, until normal values are obtained. Following this, URINE samples are requested at 4 weekly intervals until 1 year post evacuation and then every 12 weeks in the second year of follow-up. Further SERUM samples are only requested if subsequent hCG become abnormal.
(Normal values: Urine hCG 0 - 24 lU/I. Serum hCG 0 - 4 lU/l).

Patients in the 6-month follow-up group can start a new pregnancy once follow-up is complete.

Patients who do not have normal hCG values within 8 weeks of evacuation should have the 2 year follow-up. For patients in this group who are eager to go ahead with a further pregnancy, it may be judged reasonable to allow this after hCG has been normal for 6 months. In this group the risk of choriocarcinoma occurring after hCG has been normal for 6 months is 1:286.

Further estimations of hCG 6 weeks and 10 weeks AFTER ANY FUTURE pregnancies are requested because of a small increase in risk of choriocarcinoma developing in such patients. In some cases the choriocarcinoma arises from the new pregnancy.

Assay results are sent to the patient’s Gynaecologist and GP, with any relevant comment. The patient is invited to telephone for results and the first normal result is communicated to her on the subsequent request form.

Do you need to take any action on results?
We will monitor all patients very closely.
If there is an indication for chemotherapy (see below) the Gynaecologist will be contacted in the first instance. Sometimes with the permission of the Gynaecologist we will contact the patient directly to arrange admission to Charing Cross Hospital. We also endeavour to ensure the GP is informed.

Indications for chemotherapy
Patients requiring chemotherapy will meet one or more of the following criteria:

1: Serum hCG> 20, 000 IU/L at >4 weeks post evacuation.
2: Rising hCG. i.e. 2 consecutive rising serum samples.
3: hCG plateau. i.e. 3 consecutive serum samples not rising or falling significantly.
4: Heavy haemorrhage and/or severe abdominal pain.
5: hCG still abnormal at 6 months post evacuation.

Exogenous hormonal preparations for contraceptive or other purposes taken between evacuation of the mole and the return to normality of hCG values appear to increase the risk of invasive mole or choriocarcinoma developing. It is suggested that these be avoided until hCG has become normal in serum. (i.e.<5 lU/L). This advice also applies after any subsequent pregnancy, until hCG levels return to normal.