Complete hydatidiform mole when initial uterine removal has not normalised hCG within 56 days
This protocol applies when a complete molar pregnancy has already undergone initial uterine removal, yet human chorionic gonadotrophin (hCG) has not reverted to normal within 56 days of the pregnancy event — the threshold that signals persistent disease and the need for further management.
Prior treatment — escalation trigger
The initial intervention — suction curettage for uterine removal of the complete molar pregnancy — did not achieve its primary goal: reversion of hCG to normal within 56 days of the pregnancy event. This unmet endpoint is the clinical trigger for the next management step described here.
References
DOI: 10.1111/1471-0528.16266
- There is almost always a role for urgent surgical management for the woman who is experiencing heavy or persistent vaginal bleeding causing acute haemodynamic compromise, particularly in the presence of retained pregnancy tissue on ultrasound.
- Women with persistent heavy vaginal bleeding and evidence of retained pregnancy tissue on ultrasound examination may need a repeat surgical removal.
- Consideration should be given to balloon tamponade and to uterine artery embolisation to reduce the risk of hysterectomy for women who wish to preserve fertility.
- Several case series have found there may be a role for second removal in selected cases when the hCG is less than 5000 units/l.