Partial Molar Pregnancy: When Medical Removal Fails to Normalise hCG
In a partial molar pregnancy where the size of fetal parts prevents the use of suction curettage, medical removal is the appropriate first-line approach. When that treatment does not achieve its target, a further protocol is indicated.
Previous treatment and failure condition
The preceding step — medical removal of the partial molar pregnancy with anti-D prophylaxis — is considered to have failed when human chorionic gonadotrophin (hCG) does not return to normal on two samples taken at least 4 weeks apart. Persistent hCG elevation at that point indicates progression to gestational trophoblastic neoplasia (GTN) and triggers escalation to this protocol.
Treatment approach
Management at this stage involves chemotherapy for GTN, with the specific regimen determined by risk stratification — the complete protocol is available via the button below.
Clinical goal: human chorionic gonadotrophin (hCG) level returns to normal.
References
DOI: 10.1111/1471-0528.16266
- Suction curettage is the method of choice for removal of partial molar pregnancies except when the size of fetal parts deters the use of suction curettage and then medical removal can be used.
- Women with GTN may be treated with single-agent or multi-agent chemotherapy.
- Treatment is continued, in all cases, until the hCG level has returned to normal and then for a further 6 consecutive weeks.