Molar pregnancy, hydatidiform mole or H mole refers to an abnormal uterine growth where the product of the union of the egg and sperm does not become a fetus but instead, grape like sacs are formed. It is not considered to be a pregnancy since there is no embryo formed; however, the manifestations in the woman are similar to pregnancy such as positive results in the pregnancy test due to elevated human chorionic gonadotropin hormones in the body.
About 10 percent of women who have molar pregnancies experience gestational trophoblastic disease which is diagnosed by an examination of hCG levels taken 6 months after removal of the mole from the woman’s body. Trophoblastic disease is diagnosed when the concentration of hCG remains elevated even though it should be dropping.
The usual treatment for this condition is methotrexate, a chemotherapeutic drug, which would last for six months and is started after the removal of all placental fragments in the uterus. However, a recent study which was published in The Lancet tells that the use of chemotherapy regimen among women who recently had molar pregnancies is not needed anymore.
According to the article, the woman does not have to expose herself to the unwanted and uncomfortable effects of the treatment regimen just so the levels of the hCG will decrease. Putting the woman under surveillance was advised instead since most of the cases spontaneously show reduction in hCG.
The potential side effects were a cause of concern since most women who are affected by hydatidiform moles are younger than 16 and women who get pregnant beyond 45 years – thus their bodies are undergoing maturational changes that make them very susceptible to the negative effects of chemotherapy drugs.
Michael J. Seckl, a professor from the Imperial College Healthcare NHS Trust in London, chose to conduct a study investigating whether chemotherapeutic regimens are truly needed in patients who’ve suffered from molar pregnancy.
He and his team embarked on a study where women with elevated levels of hCG after 6 months of removing the hydatidiform mole are followed up and the rates of relapse, return of hCG to the normal levels, and mortality were examined. The results are compared with those of women who underwent a chemotherapy regimen and those who were placed on constant monitoring alone. The group proposed that the use of surveillance among these patients would be an acceptable intervention as long as the levels of hCG dropped in at least 75% of the patients.
Less than 1 percent or 76 out of 13,960 from the initial list of followed up women had hCG values beyond the normal levels, or above the value of 5 IU per liter. From this number, 66 patients underwent surveillance only, and later, 98% or 65 of the patients who did not undergo chemotherapy had their hormone levels return to normal. Only 1 patient did not have her hCG levels return to normal but she remains healthy - chronic kidney failure interfered with the return of the hormone to normal levels. On the other hand, only 80% of the women who underwent chemotherapy regimen had the levels of their hormone return to normal. Researchers clarified that the use of close surveillance was only adopted as long as the women do not have conditions such as trophoblastic neoplasia or trophoblastic tumor at the placenta, where the use of chemotherapy is highly needed to avert further complication of the illness.
Source: Roshan Agarwal MRCP et al. The Lancet. 29 November, 2011.