From the Guidelines
Monitoring hCG levels after a miscarriage is crucial in certain situations, particularly when there's a risk of gestational trophoblastic disease (GTD), as indicated by a plateaued or rising hCG, which occurs in 15% and 0.5%–1% of complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM) cases, respectively 1. When a patient has undergone a miscarriage, the primary concern is the potential development of GTD, which can be life-threatening if left untreated.
- The risk of GTD is higher in certain types of miscarriages, such as CHM and PHM.
- A plateaued or rising hCG level is a key indicator of potential GTD, and serial hCG measurements are essential to detect this condition early 1.
- The UK guidelines recommend measuring serum and urine hCG levels every two weeks until they return to normal, and then monthly in urine 1.
- The indications for chemotherapy in GTD include a plateaued or rising hCG, heavy vaginal bleeding, histological evidence of choriocarcinoma, and evidence of metastases in the brain, liver, or gastrointestinal tract 1.
- In cases where hCG levels are ≥20 000 IU/l >4 weeks after evacuation, chemotherapy is recommended due to the risk of uterine perforation 1.
- It is essential to note that the risk of GTD is already very low with the first normal hCG value, even for CHM, and women completing the UK scheme have an estimated 1:2000 chance of missed disease 1.
From the Research
Trending HCG after Miscarriage
- There is no direct evidence in the provided study to suggest that trending HCG is necessary after a miscarriage 2.
- The study focuses on the treatment of retained products of conception (RPOC) after a first-trimester miscarriage, comparing the efficacy of misoprostol, expectant management, and surgical intervention 2.
- The primary outcome of the study was the resolution of RPOC without surgical intervention, and it was found that 65% of patients who took misoprostol avoided dilation and curettage (D&C) 2.
- However, the study does not mention the role of HCG trending in the management of miscarriage or RPOC 2.