What is the pre-procedure preparation for a patient with a hydatidiform (H) mole undergoing suction curettage?

Pre-Procedure Preparation for Suction Curettage in Hydatidiform Mole

All patients with suspected hydatidiform mole require comprehensive pre-operative workup including quantitative serum β-hCG, complete blood count with platelets, liver and renal function tests, thyroid function tests, blood type and screen, chest X-ray, and confirmation of blood product availability before proceeding to suction curettage. 1, 2

Essential Pre-Operative Laboratory Testing

• Quantitative serum β-hCG measurement is mandatory to establish baseline levels, which typically exceed 100,000 mIU/mL in complete moles but may be lower in partial moles 1
• Complete blood count with platelets to assess for anemia from vaginal bleeding and ensure adequate platelet count for surgery 1
• Liver function tests, renal function tests, and comprehensive metabolic panel to identify any organ dysfunction 1, 2
• Thyroid function tests are critical because markedly elevated hCG can cross-react with TSH receptors causing hyperthyroidism, particularly when hCG exceeds 100,000 mIU/mL 2, 1
• Blood type and screen with cross-match for potential transfusion 1

Pre-Operative Imaging

• Pelvic ultrasound (preferably transvaginal) should be performed to confirm the diagnosis and assess uterine size 1
• Chest X-ray is recommended as baseline imaging to detect pulmonary metastases 1, 2

Critical Pre-Operative Safety Measures

• Blood products must be available in the operating room before beginning the procedure due to the significant risk of hemorrhage from these highly vascular lesions 1, 2
• Rho(D) immunoglobulin must be prepared for immediate administration to all Rh-negative patients at the time of evacuation 1
• Ultrasound guidance should be arranged for the procedure to reduce the risk of uterine perforation 1

Intra-Operative Medication Preparation

• Uterotonic agents (methylergonovine and/or prostaglandins) should be prepared for administration during the procedure and continuation for several hours postoperatively to reduce heavy bleeding risk 1

Anesthesia Considerations

• The procedure should be performed under general anesthesia or appropriate sedation to ensure patient comfort and allow for careful, controlled evacuation 2, 3

Special Considerations for High-Risk Patients

Patients with the following features require heightened preparation:

• Age >40 years 1
• hCG levels >100,000 mIU/mL 1
• Excessive uterine enlargement beyond expected gestational size 1
• Theca lutein cysts >6 cm 1

These high-risk patients have increased likelihood of progression to gestational trophoblastic neoplasia and may be considered for prophylactic chemotherapy, though this remains controversial 1

Tissue Handling Preparation

• Arrange for one tissue sample to be fixed for histopathologic examination and one unfixed sample for genetic analysis to confirm diagnosis and differentiate between complete and partial mole 3
• Consider tissue bio-banking arrangements where available for research or additional genetic testing 1

Common Pitfalls to Avoid

• Never proceed without confirming blood availability, as significant hemorrhage can occur unexpectedly during evacuation of these vascular lesions 1, 2
• Do not forget anti-D immunoglobulin for Rh-negative patients, as this must be given at the time of evacuation 1
• Avoid medical evacuation methods (such as misoprostol alone) as surgical suction curettage is the standard of care 3
• Do not use sharp curettage as the primary method due to increased perforation risk; suction aspiration followed by gentle blunt curettage is preferred 1, 4