From the Guidelines
The treatment for a molar pregnancy typically involves surgical evacuation of the uterus through dilation and curettage (D&C) to remove all abnormal tissue, as recommended by the most recent guidelines 1.
Treatment Overview
The procedure is usually performed under general anesthesia and involves dilating the cervix and using suction and a curette to remove the molar tissue.
- In some cases, especially for complete molar pregnancies or when childbearing is complete, hysterectomy may be considered as an alternative.
- Following surgical treatment, patients require close monitoring of human chorionic gonadotropin (hCG) levels weekly until undetectable for three consecutive weeks, then monthly for 6-12 months, as outlined in the guidelines 1.
Monitoring and Chemotherapy
This monitoring is crucial because approximately 15-20% of complete molar pregnancies and 1-5% of partial molar pregnancies can develop into gestational trophoblastic neoplasia (GTN), requiring chemotherapy.
- If hCG levels plateau or rise, chemotherapy may be necessary, with methotrexate (typically 50 mg/m² intramuscularly weekly) or actinomycin D being common first-line agents for low-risk disease, as recommended by the guidelines 1.
- Patients should avoid pregnancy during the monitoring period as pregnancy would elevate hCG levels and complicate surveillance.
- Effective contraception, typically hormonal methods, is recommended during this time.
Additional Considerations
- Repeat dilation and curettage or hysterectomy can be considered for persistent postmolar GTN, with hCG monitoring every 2 weeks until the patient has 3 consecutive normal assays, with monthly hCG monitoring for an additional 6 months 1.
- For evidence of metastatic disease, histopathologic diagnosis of choriocarcinoma, or persistent hCG elevation (ie, plateau or rise), follow recommendations for staging and treatment in the algorithms for GTN 1.
From the FDA Drug Label
INDICATIONS AND USAGE: Neoplastic Diseases Methotrexate is indicated in the treatment of gestational choriocarcinoma, chorioadenoma destruens and hydatidiform mole. The treatment for a molar pregnancy (hydatidiform mole) is methotrexate (2).
- Methotrexate is indicated for the treatment of hydatidiform mole.
- The use of methotrexate for this condition is supported by the drug label.
From the Research
Treatment for Molar Pregnancy
The treatment for a molar pregnancy typically involves surgical uterine evacuation with suction and blunt curettage [ 3 ]. Medical uterine evacuation is not recommended [ 3 ].
Follow-Up Care
After the uterine evacuation, serum hCG is measured weekly until the value is undetectable [ 3 ]. If serum hCG is undetectable within 56 days after evacuation, the patient can be discharged from follow-up after an additional four monthly measurements [ 3 ].
Persistent Trophoblastic Disease
If hCG stagnates, increases, or if hCG can be demonstrated for longer than 6 months, the patient is referred to oncologic treatment [ 3 ]. The primary treatment for persistent trophoblastic disease (PTD) and invasive hydatidiform mole is methotrexate (MTX) [ 3 ]. In MTX-resistant PTD, IV actinomycin D is added or replaces the MTX [ 3 ].
Key Points
- Surgical uterine evacuation with suction and blunt curettage is the recommended treatment for molar pregnancy [ 3 ]
- Serum hCG is measured weekly until the value is undetectable [ 3 ]
- MTX is the primary treatment for PTD and invasive hydatidiform mole [ 3 ]
- Uterine re-evacuation as a treatment for PTD is not recommended due to the low rate of remission and the risk of perforation of the uterus [ 3 ]
Additional Considerations
- A chest X-ray should be taken and a gynecologic ultrasound scanning performed if hCG stagnates, increases, or if hCG can be demonstrated for longer than 6 months [ 3 ]
- Safe contraception should be used during the follow-up period [ 3 ]
- In all following pregnancies, the woman is offered an early ultrasound scan, e.g. in gestational week eight [ 3 ]